Patient presents with acute onset of lower abdominal pain and vaginal bleeding.  Symptoms include sharp, stabbing, or cramping pain, possibly radiating to the shoulder.  The patient reports dizziness, lightheadedness, or syncope, consistent with potential hypovolemic shock.  Physical exam reveals abdominal tenderness, cervical motion tenderness, and adnexal mass or fullness.  A positive pregnancy test confirms pregnancy.  Transvaginal ultrasound demonstrates an empty uterine cavity and evidence of extra-uterine gestational sac or free fluid in the pelvis, consistent with a ruptured ectopic pregnancy diagnosis.  Differential diagnoses considered include pelvic inflammatory disease, ovarian torsion, and appendicitis.  Given the clinical presentation, ultrasound findings, and hemodynamic stability assessment, the diagnosis of ruptured ectopic pregnancy is made.  Treatment plan includes emergent surgical intervention via laparoscopy or laparotomy to control bleeding and remove the ectopic pregnancy.  Patient's blood type and crossmatch are ordered, and intravenous fluids are initiated for hemodynamic support.  Patient consented to the procedure and associated risks.  Pre-operative labs including complete blood count, comprehensive metabolic panel, and coagulation studies are obtained.  Patient is being closely monitored for signs of continued hemorrhage and hemodynamic instability.  ICD-10 code O00.1, Ectopic pregnancy with intraperitoneal rupture, is assigned.  CPT codes for the surgical procedure, anesthesia, and other related services will be documented upon completion of the procedure.  Post-operative care will include pain management, monitoring for complications such as infection or further bleeding, and counseling on future pregnancy planning and options.