**Question:** A female G1P1 having positive urine pregnancy test (UPT) has a CuT without the visible strings per vaginum. What is the next course of action -

A. Remove the CuT immediately and perform a clinical examination to assess for ectopic pregnancy
B. Observe the patient and perform a clinical examination to assess for ectopic pregnancy
C. Perform a transvaginal ultrasound scan to evaluate for ectopic pregnancy
D. Perform a beta-human chorionic gonadotropin (beta-hCG) test to evaluate for ectopic pregnancy

**Correct Answer:** C. Perform a transvaginal ultrasound scan to evaluate for ectopic pregnancy

**Core Concept:**
Ectopic pregnancy is a life-threatening condition where the fertilized egg implants outside the uterine cavity, usually in the fallopian tube. Early diagnosis and treatment are crucial to prevent maternal morbidity and mortality.

**Why the Correct Answer is Right:**
In this scenario, a positive urine pregnancy test indicates the presence of a gestational sac and fetal heartbeat, which implies an intrauterine pregnancy. However, the CuT is not visible due to its placement outside the cervix. Transvaginal ultrasound scan is crucial to confirm the diagnosis of an ectopic pregnancy, as it can visualize the location of the gestational sac and fetal heartbeat.

**Why Each Wrong Option is Incorrect:**

A. Observing the patient or performing a clinical examination is not sufficient to diagnose ectopic pregnancy, as clinical examination alone cannot confirm the absence of an intrauterine pregnancy or identify the location of the gestational sac.

B. Observing the patient and performing a clinical examination are essential steps in the workup of suspected ectopic pregnancy, but they cannot confirm the absence of an intrauterine pregnancy or identify the location of the gestational sac.

D. Performing a beta-hCG test is helpful in identifying the presence of a pregnancy and monitoring its progression, but it is not sufficient to confirm the absence of an intrauterine pregnancy or identify the location of the gestational sac. A transvaginal ultrasound scan is necessary for a definitive diagnosis.

**Clinical Pearls:**

Ectopic pregnancies can be potentially life-threatening if left untreated, leading to severe bleeding, rupture, and sepsis. Early diagnosis and treatment are crucial to improve maternal outcomes. Transvaginal ultrasound scan plays a vital role in confirming the diagnosis and guiding further management, including beta-hCG monitoring, administration of methotrexate, or surgical intervention if necessary.