31 yo female abd pain

[pbruss]

31 year old femal with lower abd pain and cramping for 6 hours. feels nauseous but no vomiting. no vaginal discharge or bleeding. no urinary issues. she is pregnant, LMP about a month ago. had serum beta HCG of 2200 10 days ago. has not seen an ONGYN doctor yet and no US done yet.

on exam has moderate lower abd tenderness but no guarding or rebound.

attached is her bedside US.

what is your interp and treatment?

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[kemple]

Looks ectopic to me, 2 large IV's, fluids, call OB. Would love to see a color flow of that picture to make sure not a cyst though. If there is color flow or a "ring of fire" then def ectopic. Also pregnant, weird pain and mass that's unproven = ectopic until proven otherwise.

[pbruss]

well done. for this image I can not say for sure that it is an ectopic, but there is no identifiable intrauterine pregnancy. More concerning is the presence of free fluid in the abdomen indicative of ruptured ectopic . you can see the free fluid in the left corner. (circled in red in attachment)

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