Case 129

Medical history

Twenty-six-year-old primiparous patient, demand urgent attention complaining of severe abdominal pain and brown vaginal discharge, without foul odor, about 2 hours. Reports 2 urine tests positive for pregnancy and a supposed 5 weeks and 5 days gestational age (by date of last menstruation). On physical examination, she presents algic facies, afebrile, full pulse, abdomen diffusely painful to palpation and positive Blumberg sign in the right iliac fossa. To gynaecological examination, the cervix is long, enclosed and retroverted, regular sized uterus and absence of active bleeding. The endovaginal Ultrasound was performed, see attached image.

What is the most likely diagnosis and indicated medical management?

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