A 34-year-old woman with a copper intrauterine contraceptive device (IUCD) in situ and regular cycles of 4-5/28 was referred by her general practitioner to the early pregnancy unit (EPU) at Scunthorpe General Hospital. She had amenorrhoea of 6-8 weeks duration and a positive pregnancy test. She had experienced minimal vaginal bleeding for the previous 3 weeks and had a dull ache in the left iliac fossa. She was G3 P2+0 having had two previous normal vaginal deliveries. She had relied upon her IUCD for contraception for over 4 years it had been changed 6 months previously. She had never had any adverse effects and was an ideal candidate for the use of this method of contraception being in a stable monogamous relationship with no past history of pelvic infection. She had had an appendicectomy 7 years previously but no other significant medical history. On examination the abdomen was soft with no guarding but marked iliac fossa tenderness was present. She was haemodynamically stable. There was no cervical excitation pair the uterus was mobile and a left-sided tender mass was left. The IUCD thread was seen and the device removed with the patients consent. The serum bHCG was 6515 I/l. (excerpt)