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Nursing role in urogynaecology has expanded in the modern practice especially with emerging of formulated protocols and guidelines In urogynaecology. Furthermore, conservative approaches and its success in improving patients quality of life is currently led by trained nursing staff, these areas includes pelvic floor training, bladder retraining, fluid intake modification such as explanation of the impact of caffeinated drinks on bladder activity. The adoption of pessary led nurse clinics are well established model in the current urogynaecology with significant improvement in patients flow rate across urogynaecology service provision. On the investigation side of practice, nurse led uroflowmetry and urodynamics are currently expanding with good outcomes for the patients and service capacity. Nursing role in teaching patients how self catheterise is important in those with voiding dysfunction and also prior to incontinence surgery due to associated risk of voiding difficulty.

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Methotrexate is the standard medical management for ectopic pregnancy. Pharmacologically, it is a folic acid antagonist which inhibits DNA synthesis. 90% of appropriately selected un-ruptured none live ectopic pregnancy respond to methotrexate treatment with no further management is required. In the UK, NICE guidance has identified the selection criteria to achieve the best and safest outcome in ectopic pregnancy treatment with methotrexate. Methotrexate also has a role in management of pregnancy of unknown location. Single administration of 50 mg/m2 body surface area is the most widely acceptable regimen for methotrexate in treatment of ectopic pregnancy. Post treatment b-HCG checks at day 0, 4 and 7 are also a widely accepted follow up regimen to ensure satisfactory decline in b-HCG levels. Methotrexate has a role also in managing none tubal ectopic pregnancies where surgical risks are high. Post treatment transient pain is common and represent a clinical challenge as it can also be failed treatment with ruptured ectopic pregnancy.

Electronic poster abstractsMost IEP do not rupture early in the first trimester. In this case of twin IEP, the vascular mass appeared to be significantly bulging from the uterine horn at 7 weeks gestation, raising a concern of impending rupture. Non-surgical management using local and systemic methotrexate was successful with complete resolution of the mass without complications.Supporting information can be found in the online version of this abstract P26.13 Advances in urine pregnancy testing and implications for clinical problems of early pregnancy