Difficult case on initial presentation.  Two "ring of fire structures" in the left adnexa as well as free fluid are worrisome for an ectopic pregnancy. However both are clearly within the ovary, and the intrauterine appearance is very highly suggestive of a gestational sac. The possibility of a heterotopic pregnancy with an ovarian ectopic (both rare entities) was thought to be much less likely than an intrauterine pregnancy with a second, hemorrhagic corpus luteum. 

As the patient was clinically stable, she was observed without treatment.  

Repeat ultrasound one week later shows progression of intrauterine pregnancy and resolution of the pelvic free fluid confirming the favored diagnosis of two CLs one of which causing pelvic hemorrhage and pain.

This case highlights the importance of prioritising the survival of a potential intrauterine pregnancy over early instigation of therapy in a clinically stable, potential ectopic.