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A 19-year-old G1P0000 presents for her first obstetric ultrasound after having a positive home pregnancy test. At her visit, she states that she is unsure but believes her last menstrual period was 6 weeks ago. She complains of several weeks of severe nausea with vomiting and has lost 4 pounds from her baseline weight. She also endorses some palpitations, increased perspiration, and a fine tremor of both hands. She denies vaginal bleeding. Ultrasound findings are shown in Figure A and Figure B, and her ß-hCG is 227,183 mIU/mL. Which of the following is the best next step in management?
Methotrexate therapy with serial serum ß-hCGlevels
Misoprostol and mifepristone with serial serum ß-hCGlevels
Dilation and curettage with serial serum ß-hCGlevels
Laparoscopic removal of ovarian cysts
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A 29-year-old G4P0 woman presents following a spontaneous pregnancy loss in the 18th week of her pregnancy. This is her fourth loss in the second trimester and she is concerned about her inability to have a successful pregnancy. She is otherwise healthy and has no acute complaints. Her vitals are unremarkable and exam is notable only for a firm, asymmetric uterus. Laboratory studies are ordered as seen below. Hemoglobin: 9.0 g/dLHematocrit: 30%Leukocyte count: 6,800/mm^3 with normal differentialPlatelet count: 199,000/mm^3 Serum:Na+: 139 mEq/LCl-: 100 mEq/LK+: 4.3 mEq/LHCO3-: 25 mEq/LBUN: 20 mg/dLGlucose: 99 mg/dLCreatinine: 1.1 mg/dLWhich of the following tests is most likely to elucidate the cause of this patient's pregnancy losses?