<prompt> A third gravida is admitted with complaint of sudden onset right sided lower abdominal pain after a period of 5-week amenorrhea. Her PR is 130 and BP is 8050 mmHg. TVS reveals large amount of free fluid in the pelvis and empty uterine cavity. What is the next step?Perform laparoscopyTreat with IM methotrexatePerform urgent laparotomyDo serum Beta HCG to confirm diagnosis  <response>: Ans. C. Perform urgent laparotomyAmenorrhea and lower abdominal pain with empty uterine cavity on USG raise the suspicion of ectopic pregnancy. The clinical presentation of shock and large amounts of free fluid in the pelvis point to hemodynamic instability associated with ruptured ectopic pregnancy. Therefore, this patient is managed with an urgent laparotomy. 