GP Vivas · pregnancy-and-reproductive-health
Bleeding and pain in early pregnancy — structured viva
Structured oral on early pregnancy bleeding: the PUL protocol and discriminatory zone, miscarriage management equivalence with Cochrane numbers, methotrexate selection and two-dose evidence, molar red flags and psychological aftercare.
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Study tools
Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: 'A positive pregnancy test and a scan showing nothing — is that reassuring?' The viva branches through PUL management, miscarriage choices, ectopic therapy, molar detection and grief.
Stem
You are the GP. An empty uterus on scan with a positive test sits in front of you. What now? [2]
References5ShowHide
- [1]Solangon SA, Van Wely M, Van Mello N, et al. Methotrexate vs expectant management for treatment of tubal ectopic pregnancy: an individual participant data meta-analysis Acta Obstet Gynecol Scand, 2023.PMID 37345445
- [2]Jurkovic D, Memtsa M, Sawyer E, et al. Single-dose systemic methotrexate vs expectant management for treatment of tubal ectopic pregnancy: a placebo-controlled RCT Ultrasound Obstet Gynecol, 2017.PMID 27731538
- [3]Alur-Gupta S, Cooney LG, Senapati S, et al. Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis Am J Obstet Gynecol, 2019.PMID 30629908
- [4]Nanda K, Lopez LM, Grimes DA, et al. Expectant care versus surgical treatment for miscarriage Cochrane Database Syst Rev, 2012.PMID 22419288
- [5]Seckl MJ, Sebire NJ, Berkowitz RS Gestational trophoblastic disease Lancet, 2010.PMID 20673583