On examination, the patient had a blood pressure of 130/80 and a pulse of 100 bpm. She was well orientated, afebrile and had no pallor. She had some lower abdominal discomfort with more tenderness at the left iliac fossa, but there was no rebound or guarding.
Blood tests were carried out in the form of full blood count, β-human chorionic gonadotropin (β-HCG) and progesterone.
Hb was 13.0 g/l, β-HCG was 3352 U/l and progesterone was 21 nmol/l.
A decision was made to have an ultrasound scan performed in the early pregnancy assessment unit when the first available scan slot was available (2 days later).
The patient was advised to seek medical advice if she had worsening symptoms and was discharged from A&E with simple analgesia.
She was reviewed 2 days later as planned and her pain at the time was getting worse.
The ultrasound scan failed to identify an intrauterine pregnancy, while the endometrial thickness was measured at 19.1 mm. There was a small 2.5 cm mass adjacent to the left ovary and there was also some free fluid in the pouch of Douglas.
A repeat β-HCG measurement came back as 2994 U/l and Hb was 13.3 g/l.