A 29-year-old woman with 8 weeks amenorrhoea presents with sudden severe right iliac fossa pain and syncope. Pulse 122/min, BP 78/48 mmHg, abdominal guarding present, cervix excitation positive. What is the next step in management?
- A Transvaginal ultrasound before any intervention
- B Serum beta-hCG measurement and observation
- C Immediate resuscitation with fluids and blood along with emergency laparotomy ✓
- D Diagnostic laparoscopy under general anaesthesia
Correct answer: C. Immediate resuscitation with fluids and blood along with emergency laparotomy
Explanation
A shocked patient with peritoneal signs and a positive pregnancy test implies a ruptured ectopic with haemoperitoneum. Resuscitation and immediate laparotomy take priority; waiting for ultrasound or hCG risks death from exsanguination. Diagnostic laparoscopy is inappropriate in profound shock because of limited visualization and difficulty achieving rapid control of haemorrhage. Laparoscopy is the approach of choice only in the haemodynamically stable patient.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.