Ms. Jacobs, a 34-year-old, G1P0, AB1, presents to your office with c/o right lower quadrant pain, spotting, and intermittent cramping. She denies nausea or vomiting. Her last BM was yesterday and it “looked normal.” She shares that she thinks her last normal period was about 6 or 7 weeks ago. She says she has been very busy at work. She shares that she is monogamous with one boyfriend. She has had 3 lifetime partners. Additional history she provides includes the following: NKDA, no meds at present, and has been hospitalized before for pelvic pain due to PID and treated with antibiotics. A second hospitalization was for an ectopic pregnancy and her left tube was removed. Her physical exam reveals: Patient anxious, temp 99.2 F, BP 105/62, and pulse is 95. Examination of abdomen reveals bowel sounds present, no masses, distention, or rebound tenderness. She has mild discomfort in the right lower quadrant. Pelvic exam reveals right adnexal tenderness without adnexal mass. Uterus is normal size without discomfort on cervical motion. Rectal exam is negative with heme-negative stool.
- What are your differential diagnoses? What is your final diagnosis?
- What aspects of her history and physical exam led you to your diagnosis?
- What are the risk factors for ectopic pregnancy?
- Where can ectopic pregnancies occur and how frequently do they happen?
- What labs/diagnostic tests will you order and why?
- What is your plan of management for an ectopic pregnancy?
- What education and counseling will you give to this patient?