Which of the following tests is Not useful in tubal pregnancy?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Obstetrics & Gynaecology

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2021

Explanation

Hysterosalpingography (HSG) is a radiographic procedure used to assess tubal patency, primarily for infertility investigations.
It is performed in the early follicular phase of the menstrual cycle to ensure the patient is not pregnant.
HSG is absolutely contraindicated in suspected pregnancy, including ectopic pregnancy, due to the significant risk of rupturing the fallopian tube and causing harm from radiation exposure.
The procedure involves injecting contrast dye under pressure, which is dangerous when an embryo is implanted in the tube.

Option A: HCG testing is essential for diagnosing and monitoring a suspected tubal pregnancy. It confirms the presence of a pregnancy, and the pattern of its rise (or plateau) helps differentiate an ectopic pregnancy from a normal or failing intrauterine pregnancy.
Option B: Ultrasonography (USG), specifically transvaginal sonography (TVS), is the primary imaging modality for diagnosing a tubal pregnancy. It is used to locate the gestational sac and is considered the gold standard.
Option C: A pelvic examination is a useful part of the initial clinical assessment. It can reveal key signs like adnexal tenderness, a palpable mass, or cervical motion tenderness ('chandelier sign'), which are highly suggestive of a tubal pregnancy.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Diagnostic procedures for ectopic (tubal) pregnancy as background academic context rather than a clinical decision trigger.
A ruptured ectopic pregnancy is a life-threatening medical emergency. Nurses must be vigilant in recognizing the signs: sudden, sharp, severe lower abdominal pain, dizziness, shoulder pain (from diaphragmatic irritation by blood), and signs of shock (hypotension, tachycardia).
The nurse's role includes preparing the patient for diagnostic tests, monitoring vital signs closely for any indication of rupture, providing emotional support, and preparing for potential surgical intervention (salpingectomy or salpingostomy) or medical management with methotrexate.
What if? If a patient with a suspected ectopic pregnancy presents with unstable vital signs (e.g., low blood pressure, high heart rate), the priority shifts from diagnostic testing to immediate surgical intervention to control hemorrhage, as this indicates a likely rupture.

How to Approach the Question

First, identify the core of the question: it asks which test is 'Not useful' for a 'tubal pregnancy'. This is a negative-framing question.
Evaluate each option's role in the context of a suspected ectopic pregnancy.
Option A (HCG): Recall that HCG is the hormone that confirms pregnancy. Its levels are monitored to assess viability. This is useful.
Option B (USG): Recall that ultrasound is used to visualize the uterus and adnexa to locate the pregnancy. This is very useful.
Option C (Pelvic examination): Recall that a physical exam can elicit signs of peritoneal irritation or an adnexal mass. This is useful.
Option D (Hysterosalpingography): Recall that HSG involves injecting dye to check if tubes are open, a test for infertility. Consider the risks of doing this during a pregnancy. It's invasive and involves radiation. This is not useful and is dangerous.

Concept Tested & Keywords

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E6 Gynecology Williams p. 48-73