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Ectopic Pregnancy

Out of place

Step 1: View clinicals

A 29 year old woman presents with severe pain in the lower abdomen and right iliac fossa for 2 days. A week ago she presented with pelvic pain and vaginal bleeding, and was diagnosed with a complete miscarriage as her urine hCG test was positive and the ultrasound abdomen showed an empty uterus. Her last regular menstrual period was 6 weeks ago. A repeat urine hCG test is positive.

Step 2: Order all relevant investigations

Serum beta-hCG

The serum beta-hCG level is 1500 IU/L.

Transvaginal ultrasound

A right sided adnexal mass measuring 2 x 2.5 x 2 cm is noted. There is no evidence of cardiac activity. The uterus is empty. There is no free fluid in the pelvis.

Chest X-Ray

The x-ray appears normal.

Full Blood Count

WBC/DC: 8,000/mm3 (4,600 - 11,000) Hb: 12.2 g/dl (11.5 - 18.5) Platelets: 324,000/mm3 (150,000 - 450,000)

Step 3: Select appropriate management

IM Methotrexate
Oral Doxycycline
Emergency Laparotomy
S/C Morphine

Score: ★★☆