A 29-year-old woman presents to a community sexual and reproductive health clinic with 24 hours of left-sided pelvic pain and light vaginal bleeding.

Question

A 29-year-old woman presents to a community sexual and reproductive health clinic with 24 hours of left-sided pelvic pain and light vaginal bleeding. A 52 mg levonorgestrel intrauterine device was inserted 18 months ago. She has previously been amenorrhoeic but reports breast tenderness and nausea for 2 weeks. She is uncertain whether she would continue a pregnancy. Her pulse is 82 beats/min, blood pressure 118/72 mmHg and temperature 36.7°C. There is mild left lower-quadrant abdominal tenderness without guarding. Speculum examination confirms slight bleeding through a closed cervical os; the device threads are visible. Bimanual examination elicits left adnexal tenderness without cervical excitation. A urine pregnancy test is positive. Which is the most appropriate immediate management plan?

Accepted Answer

Refer immediately to an early pregnancy assessment service for transvaginal ultrasonography, leaving the device undisturbed until pregnancy location is established

Answer

Arrange routine transvaginal ultrasonography within 7 days, with emergency assessment if pain, bleeding or haemodynamic status worsens

Answer

Measure serum hCG now and after 48 hours, referring for ultrasonography if the change is outside the expected range

Answer

Remove the device using the visible threads, then arrange early pregnancy assessment within the next 7 days

Answer

Commence empirical pelvic inflammatory disease treatment, retain the device and review the clinical response after 48–72 hours

Suspected ectopic pregnancy with intrauterine contraception in situ — DFSRH MCQ