Ectopic pregnancy Quiz: Ace Your Exams
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An 18-year-old woman presents to the emergency department with lower abdominal pain that has been progressively worsening for the past 4 days. She also has vaginal spotting that began 3 days ago. The first day of her last menstrual period was 6.5 weeks ago. She is sexually active with a single male partner and uses condoms inconsistently. Past medical history is notable for menarche at age 12, regular menstrual cycles, and two chlamydial infections within the past year that were treated with antibiotics. She currently takes no medication. Temperature is 37.1 °C (98.7 °F), heart rate is 90 bpm, respirations are 18/min, and blood pressure is 110/76 mmHg. The pelvic exam shows normal physiologic vaginal discharge, a closed cervical os with a scant amount of dried blood in the vaginal vault, and moderate right adnexal tenderness. Human chorionic gonadotropin (HCG) is 4400 mIU/ml. Transvaginal ultrasound shows an empty uterine cavity with a 3.7 cm complex right-sided adnexal mass. No gestational sac is seen. Which of the following is the best next step in management?
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