30 year old G3P2 woman had her last normal..... - azsmu

[ArchivalUser]

30 year old G2P3 woman had her last normal menstrual period 8 weeks ago. She began spotting 3 days ago and developed cramping this morning. She has a history of Chlamydia infection with a previous pregnancy. She has no history of other STDs and is currently sexually active with one partner. She smokes 1 pack of cigarettes per day and denies alcohol or drug use. On physical exam, her blood pressure is 120/70, pulse 82, respiration 20, and temp. 98.5 . On physical exam, she has suprapubic and diffuse bilateral lower quandrant tenderness, but no rebound or guarding. On pelvic exam, she has normal external genitalia, old blood in the vaginal vault, the cervix is without lesion and os closed. Pertinent labs: Quantitative BhCG = 1000mIU/ml; urinalysis normal; hematocrit = 32%; transvaginal ultrasound shows no intrauterine pregnancy, no adnexal masses, no free fluid in pelvis. What is the most appropriate next step in the management of this pt?

1. Treat with Methotrexate
2. Exploratory surgery
3. Repeat hCG in 48 hours
4. Dilation and Curettage
5. Repeat ultrasound in one week

[ArchivalUser]

33

[ArchivalUser]

3.

[ArchivalUser]

I think it is 1.

[ArchivalUser]

333,

how could it be 1? You aren't sure it is an ectopic pregnancy yet. You can't jump straight to treatment until you have a diagnosis.

[ArchivalUser]

_ 111

[ArchivalUser]

33