Female of child
bearing age with
abd pain and/or Emergency Department Clinical
and “+” urine Algorithm:
for Ectopic Pregnancy
Hct > 30 Bedside
HD normal Transabdominal
Light to mod / Transvaginal
vag bleeding US
Discharge with Consult OB IUP Failed Ectopic Indeterminate
follow up and Pregnancy
Discharge with Consult OB Consult OB Beta Quant Beta Quant
routine OB <1500 >1500
No free fluid in Free fluid in HD abnormal 1. Formal US
cul-de-sac, no cul-de-sac,
adnexal mass, adnexal mass, 2. Consult OB
1st Trimester Bedside US Exam: no ovarian cyst,
Hct >30 and HD
1. Sagittal and Transverse normal Hct<30
views of Uterus
2. Orthogonal views of
3. Evaluation of the cul-de- Notify OB and 1. Consult OB Consult OB
sac for free fluid discharge home
with return 2. Formal US
4. Measurements of GS, FP, ectopic
FHR where applicable precautions***
and 48 hour OB
* Return Miscarriage Precautions = Return if heavy vaginal bleeding or passing tissue.
** Failed Pregnancy = 1. Fetal Demise (fetal pole >7mm without evidence of cardiac activity) 2. Anembryonic gestation (gestational sac
>20 mm with a YS present and no fetal pole)
*** Return Ectopic Precautions = Return if worsening abdominal pain, lightheadedness, weakness or increased vaginal bleeding.
All patients with evidence of vaginal bleeding who are Rh negative and <13 weeks, require a50mcg of RhoGam regardless of disposition.
This algorithm does not apply to patients on fertility medications or receiving in-vitro fertilization procedures.
This algorithm is not intended to replace clinical judgment. If the patient presents with signs of hypovolemic shock, immediate OB
consult is warranted before the collection of all diagnostic data.