Approach to acute pelvic pain (GYN) Quiz: Ace Your Exams

A 28-year-old woman comes to the emergency department for evaluation of right-sided pelvic pain for the last week and light vaginal spotting. Today, the pain became severe, and the patient subsequently developed lightheadedness. The patient has not had a fever or vomiting. She had pelvic inflammatory disease two years ago and is currently sexually active with one biologically male partner. Her periods are irregular, and she reports that her last normal menstrual cycle was three months ago. Temperature is 37.0°C (98.6°F), pulse is 132/min, respiratory rate is 22/min, blood pressure is 88/62 mmHg, and oxygen saturation is 98% on room air. On examination, the patient appears pale and in pain. There is diffuse abdominal tenderness with rebound tenderness and guarding. Serum hCG is 3,900 IU/L. Ultrasound shows evidence of an adnexal mass and free fluid in the pelvis. There is no intrauterine pregnancy visualized. Which of the following is the best next step in management?