This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are an ST4 doctor covering Early Pregnancy Assessment Unit (EPAU). You have been asked to see 24- year- old Jaz Pringle in her third pregnancy. Her LMP was six weeks ago and has presented with left iliac fossa pain and light vaginal bleeding. Your task is: … ● To take a focussed history ● Organize the necessary investigations ● Discuss the results and diagnosis with Jaz ● Agree a management plan … You have 10 minutes for this task (+ 2mins initial reading time). This is a communication skills clinical assessment task that tests the candidate’s skills to take a focussed history, interpret and explain results and agree to a management plan having discussed the options. If they ask for the urine pregnancy test, tell them it is positive. If they arrange an ultrasound, provide them with the following result. ‘An empty uterus and a 2.3cm left sided adnexal mass with well- defined gestational sac medial to the left ovary with minimal fluid in pouch of Douglas. Right ovary appeared normal. Findings are highly suggestive of left sided tubal pregnancy’. If they organize beta HCG, tell them the nurse had sent it and the result is back and it is 2900IU/ml. Record your overall clinical impression of the candidate for each domain (e.g. should this performance be pass, borderline, or a fail). You are Ms. Jaz Pringle, a 24- year- old housewife who lives with her partner of four years. You have one child delivered by caesarean section for breech (bottom first) presentation three years ago. You had developed infection post caesarean section and were very unwell. You had needed admission to the hospital for 10 days and needed IV antibiotics. This was followed by an ectopic pregnancy 18 months ago whereby you ended up having key hole surgery and removal of your right fallopian tube with ectopic pregnancy. While you have not been actively trying for another pregnancy, you and your partner are happy with the thought of another pregnancy. However, you attended hospital due to some discomfort on the left side of the tummy and some vaginal bleeding on and off for two days. You are otherwise fit and well with no allergies. The candidate should arrange a urine pregnancy test, which will be positive. They should then organize a scan in the EPAU. The scan will suggest an ectopic pregnancy in your right tube. You are now extremely upset and anxious after the scan at the thought of possibly losing the only remaining tube and being rendered infertile. You want to know all possible options and would like to save the only fallopian tube if possible.
A Ruptured Ectopic Pregnancy Presenting with a Negative Urine Pregnancy Test
