A 26-year-old woman comes to the office because of a 3-day history of lower abdominal pain. She is 18 weeks pregnant by dates. The patient describes the pain as sharp, steady, and radiating across her lower abdomen bilaterally. Last night she developed new nausea and vomiting. She has not been able to keep down any food or drink this morning. She had a normal bowel movement yesterday. She says she felt cold and shivering this morning, followed by feeling warm; however, she did not check her temperature. She denies vaginal bleeding.
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