A woman comes to the emergency department complaining of pain in the right side of the abdomen, she has 7 weeks amenorrhea. Her pregnancy test is +ve and US scan shows an empty uterus. What is the next step?

A. Laparoscopy. [Surgery should be offered to those women who cannot return for follow-up after methotrexate or to those who have any of the following:

• Significant pain.

• Adnexal mass ≥35 mm.

• Fetal heartbeat visible on scan.

• Serum hCG level ≥5000 IU/L.

A laparoscopic approach is preferable. A salpingectomy should be performed, unless the woman has other risk factors for infertility, in which case a salpingotomy should be undertaken]. [If HCG >6000IU/L and an intrauterine gestational sac is not seen on trans-abdominal US, ectopic pregnancy is very likely, as is the case if HCG 1000–1500IU/L and no sac is seen on transvaginal Ultrasound].