Answer: E - This female patient presents with classic symptoms of unruptured ectopic pregnancy, namely abdominal pain, vaginal bleeding or spotting in a woman with previous amenorrhea, cervical motion tenderness with blood present in the vaginal vault, and blue coloration to the cervix as in a normal pregnancy. For the presentation of classic clinical symptoms of unruptured ectopic pregnancy, the initial diagnostic test is a simple bedside urine pregnancy test.
If negative and clinical symptoms still suggest ectopic pregnancy, a quantitative serum beta bCG is obtained. If confirmed, then an ultrasound is performed to rule out intrauterine pregnancy and possibly locate ectopic pregnancy as well. If ultrasound cannot locate the ectopic pregnancy, a gynecologic surgery consult is recommended for exploratory laparoscopy. Dilatation and curettage are indicated to ascertain if intrauterine pregnancy exists and to terminate it if present.
