Question 1

1. Your patient is a 25 year old female that had a positive pregnancy test at home.  She presents with pelvic pain and vaginal bleeding.  Her LMP was approximately 5 weeks ago but she is not sure.  Her quantitative HCG is 746 and her pelvic ultrasound shows no fetal pole seen on ultrasound.  The remainder of the ultrasound is negative.  Which of the follow is the most correct action?

1. She unfortunately has miscarried.  Advise pelvic rest and bed rest.  Have her follow up with her OB in 2 weeks.
2. This is an incomplete miscarriage.  There has to be fetal remnants if the quantitative HCG is still up.  She is going to need a D and C.  Refer to OB and try to get her in a week.
3. This is an ectopic pregnancy.  Call OB and recommend an immediate laparoscopy and salpingectomy
4. Recommend follow up quantitative HCG in 48 hours with possible repeat ultrasound.   It is impossible to rule out an ectopic pregnancy at this point.