<prompt> Basanti, a 28 yrs aged female with a history of 6 weeks of amenorrhoea presents with pain in abdomen; USG shows fluid in pouch of douglas. Aspiration yields dark color blood that fails to clot.Most probable diagnosis is:Ruptured ovarian cystRuptured ectopic pregnancyRed degeneration of fibroidPelvic abscess  <response>: The picture given in the question classically represents a case of ruptured ectopics pregnancy.Symptoms In Ectopic pregnancy triad of:Amenorrhea seen in 75 cases followed by:Abdominal pain seen in 100 cases, it is the most consistent symptom of ectopic pregnancy.Appearance of vaginal bleeding are seen:The above triad may be accompanied by nausea, vomiting, fainting attacks or syncope.Patient may present in shock with pallor, tachycardia, hypotension and cold clammy extremities, if ectopic pregnancy has rupturedExamination:General examination: In case of rupturePR Pallor ntBP Slight intermittent pyrexia due to absorption of products of degeneration.Per Abdomen - Abdomen is tense, tender and distended.Shifting dullness may be present depending on the amount of hemorrhage in ruptured ectopic.Rigiditymuscle guarding ,Cullens sign - bluish discolouration around the umbilicus may be present.On Bimanual examinationVaginal mucosa appears blanched.Uterus: normal sizeslightly bulky.Extreme tenderness on cervical movementFornices-tender Remember - tenderness in pelvis is the most constant sign of Ectopic pregnancy.UL adnexal mass: is palpable in one third to half of patient.Culdocentesis:It is a simple technique used to identify hemoperitoneum.Fluid is aspirated from cul-de-sac via posterior fornix with the help of a needle.If non clotting blood is obtained, it is indicative of an intraperitoneal bleed and probably a ruptured ectopic. 