A woman with lower quadrant pain, positive pregnancy test, and suspected ectopic pregnancy. What is the initial action?

• A. Immediate intrauterine ultrasound
• B. Schedule elective delivery
• C. Perform a transvaginal ultrasound and avoid vaginal examination until stable; monitor for bleeding
• D. Begin antibiotics

Answer: (C)

In suspected ectopic pregnancy, the priority is to assess stability and determine where the pregnancy is located using imaging. A transvaginal ultrasound is the best initial study because it provides a clear view of the uterus, fallopian tubes, and adnexa and can identify an ectopic pregnancy or free fluid that signals rupture. This imaging guides how urgently to intervene.

Avoiding a vaginal examination until the patient is stable is important because if there is a ruptured ectopic or heavy intra-abdominal bleeding, internal exam can exacerbate hemorrhage and complicate resuscitation. While awaiting imaging, monitor for bleeding and signs of shock, establish IV access, and prepare for possible surgical intervention if the situation worsens.

Antibiotics or scheduling delivery aren’t appropriate initial steps in this acute scenario; treatment depends on stability and imaging findings.