Sudden Pelvic Pain and Syncope at 7 Weeks

Presentation

A 27-year-old woman presents with sudden severe right lower quadrant pain that began 1 hour ago, followed by a brief syncopal episode. Her last menstrual period was 7 weeks ago, and she reports light vaginal spotting. She has a history of chlamydial pelvic inflammatory disease and uses no contraception.

T 37.0°C, HR 122, BP 88/54, RR 20, SpO2 99% on room air; diffuse abdominal tenderness with rebound