Which of the following findings most strongly indicates a sizable intra-abdominal hemorrhage in a ruptured ectopic pregnancy?

Symptoms and signs of Ectopic pregnancy - "Classical" cases are characterized by variably delayed menstruation followed by slight vaginal bleeding or spotting. With rupture, there is usually severe lower abdominal and pelvic pain that is frequently described as sharp, stabbing, or tearing, while the patient may also present with hypotension, tachycardia, or even shock The posterior vaginal fornix may bulge because of blood in the rectouterine cul-de-sac, or a tender, boggy mass may be felt to one side of the uterus. Symptoms of diaphragmatic irritation, characterized by pain in the neck or shoulder, especially on inspiration, develop in women with sizable intraperitoneal hemorrhage.