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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.
What is your interpretation of the ultrasound images?
How would the quantitative β-hCG alter your interpretation?
What is the appropriate disposition for this patient?
1. The first image (A) is the …
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.