With the knee extended, it adducts the thigh and flexes the hip. The pectineus has its origin on the iliopubic eminence laterally to the gracilis and, rectangular in shape, extends obliquely to attach immediately behind the lesser trochanter and down the pectineal line and the proximal part of the linea aspera on the femur. It is a flexor of the hip joint, and an adductor and a weak medial rotator of the thigh. The adductor brevis originates on the inferior ramus of the pubis below the gracilis and stretches obliquely below the pectineus down to the upper third of the linea aspera. Except for being an adductor, it is a lateral rotator and weak flexor of the hip joint.The adductor longus has its origin at superior ramus of the pubis and inserts medially on the middle third of the linea aspera. Primarily an adductor, it is also responsible for some flexion. The adductor magnus has its origin just behind the longus and lies deep to it. Its wide belly divides into two parts: One is inserted into the linea aspera and the tendon of the other reaches down to adductor tubercle on the medial side of the femurs distal end where it forms an intermuscular septum that separates the flexors from the extensors. Magnus is a powerful adductor, especially active when crossing legs. Its superior part is a lateral rotator but the inferior part acts as a medial rotator on the flexed leg when rotated outward and also extends the hip joint.
Discomfort in the middle of the abdomen is more closely associated with spontaneous abortion; discomfort on a side of the abdomen is more closely associated with ectopic pregnancy. Risk factors for ectopic pregnancy or spontaneous abortion should also be considered.The physical examination includes assessing vital signs and performing an abdominal and pelvic examination. Signs of hemodynamic instability or peritonitis require emergent intervention. A pelvic examination may reveal non-obstetric causes of bleeding such as bleeding from the vagina or cervix. It may also show visible products of conception suggestive of an incomplete abortion.If the person is stable and a pelvic exam is unrevealing, transvaginal ultrasonography and/or serial measurement of hCG is generally recommended to assess fetal location and viability. Reviewed data from observational studies determined that ultrasound examination and hCG concentration could replace pelvic examination in the initial evaluation of early pregnancy bleeding. Transvaginal ultrasound is frequently used in the evaluation of bleeding in early pregnancy.Before 10 weeks gestation, a slower than normal increase in hCG suggests early pregnancy loss or ectopic pregnancy. By approximately 10 weeks, hCG plateaus and ultrasound is preferred to determine the location of the pregnancy (i.e., intrauterine or ectopic). In the presence of prior pelvic imaging, fetal heart tracing with Doppler sonography is sufficient to assess fetal viability beginning at 10–12 weeks of gestation. Bleeding associated with an intrauterine, viable pregnancy suggests threatened early pregnancy loss. Bleeding associated with an intrauterine, nonviable pregnancy suggests early pregnancy loss.