A lady aged 42 years Gravida 5 para 4 with h/o amenorrhea 6.5weeks urine pregnancy positive C/o spotting no h/o of pain abdomen USG showed empty uterus nothing in adnexa bhcg titre 3900iu/ml. After 1 week pt had bleeding for 1week no h/o pain abdomen.
After 3 weeks at gestational age of 10 weeks 2 days patient had severe pain abdomen and shoulder pain which was treated by local doctor and pain subsided Patient vitals stable USG showed less than 50ml fluid in pouch of Douglas no tenderness in cervix or adenexa bhcg titre 1087iu/ml min pain abdomen present. Please advise.
