A 22-year-old woman presents with knifelike, cramping pelvic pain and vaginal bleeding for six hours. She reports her last menstrual period was six weeks ago and vital signs are normal. Abdominal examination shows tenderness in the lower quadrants bilaterally. What is the most appropriate initial study to order?

• A. Pregnancy Test
• B. Pelvic ultrasound
• C. Serum hCG
• D. Urinalysis

Answer: (A)

In a reproductive-age woman with acute pelvic pain and vaginal bleeding, the first step is to determine whether pregnancy is present. A quick pregnancy test (urine hCG) is the fastest, least invasive way to confirm or exclude pregnancy in the emergency setting.

If the test is positive, you would follow with quantitative serum hCG and a transvaginal ultrasound to assess viability and location (intrauterine versus ectopic) and to evaluate for miscarriage. If the test is negative, you can pursue nonpregnant causes of pain and bleeding.

Starting with pregnancy testing prevents misinterpretation of later imaging and ensures you choose the right next steps promptly.