## Clinical Diagnosis This patient presents with a ruptured ectopic pregnancy requiring emergency surgical intervention. ### Key Diagnostic Features | Finding | Significance | |---------|-------------| | Positive pregnancy test + empty uterus | Rules out intrauterine pregnancy | | Free pelvic fluid on ultrasound | Indicates hemoperitoneum | | Hemodynamic instability (BP 100/65, HR 110) | Signs of hemorrhagic shock | | Acute severe pain with peritoneal signs | Rupture with active bleeding | | β-hCG 8,500 mIU/mL | High level consistent with ectopic | **Key Point:** A ruptured ectopic pregnancy with hemodynamic compromise is a surgical emergency. Expectant management and medical therapy are contraindicated in unstable patients. **Clinical Pearl:** The combination of positive pregnancy test, empty uterus, free pelvic fluid, and hemodynamic instability is pathognomonic for ruptured ectopic pregnancy and mandates immediate surgical exploration. **High-Yield:** In a hemodynamically unstable patient with suspected ectopic pregnancy, do NOT delay for further imaging or medical management — proceed directly to laparotomy for hemorrhage control and salpingectomy or salpingostomy. ### Management Algorithm ```mermaid flowchart TD A[Confirmed ectopic pregnancy]:::outcome --> B{Hemodynamically stable?}:::decision B -->|No| C[Ruptured/unstable]:::urgent C --> D[Emergency laparotomy]:::action D --> E[Salpingectomy or salpingostomy]:::action E --> F[Control hemorrhage]:::action B -->|Yes| G{β-hCG level & tube diameter?}:::decision G -->|Low β-hCG, small tube| H[Medical management: Methotrexate]:::action G -->|High β-hCG or large tube| I[Surgical management: Laparoscopy]:::action ``` [cite:Jeffcoate's Principles of Gynecology 8e Ch 14]
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