What clinical scenario warrants consideration of ectopic pregnancy?

• A. Postpartum fever
• B. Severe lower abdominal pain in a woman of childbearing age
• C. Headache in a teenager
• D. Chest pain in a male patient

Answer: (B)

Severe lower abdominal pain in a woman of childbearing age should prompt consideration of an ectopic pregnancy because pregnancy may be implanted outside the uterus and rupture can cause life-threatening bleeding. This scenario often coexists with missed periods or vaginal bleeding, and exam may reveal abdominal or adnexal tenderness. The first steps are a pregnancy test and assessment of the patient’s stability, followed by a transvaginal ultrasound to locate the gestation and look for signs of an ectopic pregnancy (such as an empty uterus, adnexal mass, or free fluid). Serial measurements of beta-hCG can help determine if a pregnancy is progressing normally toward intrauterine implantation. If rupture or hemodynamic instability is present, urgent surgical intervention is required; if stable and unruptured with appropriate criteria, medical management with methotrexate may be considered. Other options don’t fit because postpartum fever points to infection, headache in a teenager is unrelated, and chest pain in a male patient is not compatible with a pregnancy-related emergency.