If a 25 year-old presents with pelvic pain and uterine bleeding, which test is the next best in evaluation if her Beta-HCG levels are increasing?

In the scenario of a 25-year-old woman presenting with pelvic pain and uterine bleeding, and with increasing Beta-HCG levels, the next best step in evaluation is a transvaginal ultrasound. This imaging modality is particularly valuable because it helps to assess the status of the pregnancy, determine the location (intrauterine versus ectopic), evaluate for any complications, and identify potential causes of bleeding or pain such as ovarian cysts or other pathologies in the reproductive organs.

Transvaginal ultrasound provides high-resolution images and allows for the assessment of the uterine lining and surrounding structures, which is critical when considering potential diagnoses such as miscarriages, ectopic pregnancies, or other abnormalities. Given the clinical context of rising Beta-HCG levels, it is essential to ascertain whether the pregnancy is developing normally within the uterus or if there are any indications of an ectopic pregnancy, which could be life-threatening.

Other tests like laparoscopy or dilation and curettage are more invasive procedures and are typically considered later in the evaluation process if indicated by the ultrasound findings. Culdocentesis, while useful in some scenarios, is less common for this specific presentation and does not provide the detailed information regarding the uterus and adnexa that transvag