A woman arrives for evaluation of her symptoms, which include a missed period, adnexal fullness, tenderness, and dark red vaginal bleeding. On examination the nurse notices an ecchymotic blueness around the woman's umbilicus and recognizes this assessment finding as:

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Cullen's sign is a bluish discoloration around the umbilicus that indicates intra-abdominal bleeding. In this case, it is likely caused by a ruptured ectopic pregnancy. Missed periods, adnexal fullness, tenderness, and vaginal bleeding are also suggestive of an ectopic pregnancy. Turner's sign (B) is associated with appendicitis and presents as a bluish discoloration around the flank area. Chadwick's sign (D) is a bluish discoloration of the cervix and vagina that occurs in early pregnancy due to increased blood supply to the area. Normal integumentary changes associated with pregnancy (A) do not involve a bluish discoloration around the umbilicus.

A Woman Arrives for Evaluation of Her Symptoms, Which Include