22 year old female presents to the emergency department with | Figure 1

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22 year old female presents to the emergency department with complaint of vaginal bleeding. She was due for her period 3 weeks ago but it never came. This morning she noticed some spotting, the passing of a few clots, and some lower abdominal cramping. There has been no other vaginal discharge, no other abdominal pain. What is your differential? What does the ultrasound show? What additional testing is needed? Is she safe for discharge home?

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