Answer 1

1.  Answer D is the correct answer.  It is impossible to rule out or rule in an ectopic pregnancy at this point.  The standard of care is to follow the quantitative HCG in 48 hours to see if it doubles.  The differential diagnoses in this patient are early intrauterine pregnancy not seen, incomplete miscarriage, or early ectopic pregnancy not seen yet.  If the quantitative HCG is increasing, it advised to follow the ultrasound to see if a fetal pole is visible.  If the quantitative HCG is over 1000-2000 a fetal pole should be visible.  There is no way to tell at this point if a D and C is indicated.