A 26 year old female came to the ER with C/O nausea and vomiting since one day with 6 weeks amenorrhea. Pvt hospital USG Abd & Pelvis report S/O Ruptured Right Ectopic Gestation with free fluid in POD.
Obstetric H/O :
3 previous LSCS with 3 healthy female children sterilization done after the 3rd child.
Patient remarried and underwent tubal recanalization.
P/A : Soft , Right Iliac fossa tenderness+
Uterus - anteverted
Rt fornix- fullness + , tenderness+
Urine Pregnancy Test +
Beta - HCG levels : 326.2 mIU/ml
Trans abdominal USG -
Cystic lesion in the Rt ovary 2.8cm*3.2 cm s/o Dominant follicle??
What is the probable diagnosis?
What would be the next step of investigation?