Ectopic pregnancy Quiz: Ace Your Exams

A 20-year-old woman comes to the emergency department for severe abdominal pain that has been progressively worsening over the past 3 days. Her last menstrual period was 7 weeks ago, and she is sexually active with a single male partner. Her only medication is oral contraceptive pills, which she takes inconsistently. Temperature is 37.9 °C (100.2 °F), heart rate is 110 bpm, respirations are 26/min, and blood pressure is 90/60 mmHg. Abdominal examination reveals abdominal distension with rigidity, flank tenderness, and rebound tenderness radiating to the right shoulder. The patient becomes increasingly drowsy during the examination with a faint and thready pulse. Fluid resuscitation is urgently started, and blood products are ordered. Transvaginal ultrasound reveals significant free fluid in the pelvis, a complex right-sided adnexal mass, and an empty uterine cavity. Human chorionic gonadotropin is 4,035 IU/L (reference range: <5 IU/L). Which of the following is the best next step in management?