Scope of Application
This guideline is intended for physicians working in hospital-based emergency departments.

Inclusion Criteria
This guideline is intended for stable patients (with normal blood pressure and pulse rate) in the first trimester of pregnancy who have abdominal pain or vaginal bleeding, without a previously confirmed intrauterine pregnancy.

Exclusion Criteria
This guideline is not intended to address the care of patients who are clinically unstable, have had abdominal trauma, or are at higher risk for heterotopic pregnancy such as those who are undergoing fertility treatments.

Critical Questions

1. Should the emergency physician obtain a pelvic ultrasound in a clinically stable pregnant patient who presents to the emergency department with abdominal pain and/or vaginal bleeding and a β-human chorionic gonadotropin (β-hCG) level below a discriminatory threshold?
   
   Level B Recommendation:
   
   Perform or obtain a pelvic ultrasound for symptomatic pregnant patients with any β-hCG level.
   
   
   
2. In patients who have an indeterminate transvaginal ultrasound result, what is the diagnostic utility of β-human chorionic gonadotropin (β-hCG) for predicting possible ectopic pregnancy?
   
   Level B Recommendation:
   
   Do not use the β-hCG value to exclude the diagnosis of ectopic pregnancy in patients who have an indeterminate ultrasound result.
   
   Level C Recommendation:
   
   Obtain specialty consultation or arrange close outpatient follow-up for all patients with an indeterminate pelvic ultrasound result.

Disclaimer
Recommendations offered in this policy are not intended to represent the only diagnostic and management options that the emergency physician should consider. ACEP recognizes the importance of the individual physician's judgment and patient preferences.