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Short answer question case series: symptomatic first-trimester pregnancy
  1. Alisa K Sato,
  2. Timothy B Jang
  1. Department of Emergency Medicine, David Geffen School of Medicine UCLA, Harbor-UCLA Medical Center, Torrance, California, USA
  1. Correspondence to Dr Timothy B Jang, Department of Emergency Medicine, David Geffen School of Medicine UCLA, Harbor-UCLA Medical Center, Torrance, California, USA; tbj{at}ucla.edu

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Case vignette

A 21-year-old woman gravida 3 para 1, about 8 weeks pregnant, presents with lower abdominal pain. She describes the pain as crampy and intermittent associated with mild vaginal bleeding. On physical exam her blood pressure is 120/60 and her heart rate is 75, with mild bilateral lower abdominal tenderness to deep palpation. Labs are currently pending, including a quantitative β-hCG, which is a 4 h send out. Urinalysis shows seven white blood cells, three red blood cells and two epithelial cells with 1+ leucocyte esterase and no nitrates. You decide to perform a transabdominal and transvaginal ultrasound. The patient has had her left ovary removed in the past due to a haemorrhagic cyst and therefore left adnexal pictures are not included.

Key questions

  1. What is your interpretation of the ultrasound images?

  2. How would the quantitative β-hCG alter your interpretation?

  3. What is the appropriate disposition for this patient?

Discussion

1. The first image (A) is the …

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