A 40-year-old woman presented with vaginal bleeding to Gynecology ward. The bleeding had started two days earlier and was getting severe. The bleeding had happened after lifting a heavy box and was associated with abdominal pain. The pain was generalized and was associated with vomiting. She had no past medical history and was using contraceptive pill user. She had 2 children, both delivered via cesarean.
She did not have any evidence of sexually transmitted disease. On presentation, her blood pressure was 90/60, she was tachycardic at 96, and her body temperature was 37.2°C. On examination, the uterus was tender in palpation, and cervix had a normal appearance with a heavy bleeding. Her abdomen was generally tender. Differential diagnosis consisted of ectopic pregnancy (EP), abortion, rupture of an ovarian cyst, endometrial cancer, uterine sarcoma, degenerating myoma, pelvic…
