hemoglobin (or CBC)
Beta-HCG (quantitative)
Type and Screen with Rh Factor
FAST and Pelvic US
Using this algorithm should always favor considering<unk>  if there is any evolution or change in a patient's clinical exam
Assess for Shock
Beware that paradoxical bradycardia can be present with significant hemoperitoneum
If patient is a high risk for<unk>  based on above estimation then immediately contact OBGYN
Beware that paradoxical bradycardia can be present with significant hemoperitoneum
Perform a Pelvic US
Consider Transabdominal Ultrasound  for B-HCG: >6000 mIU/ml (but if negative or indeterminate must do Pelvic ultrasound regardless of B-HCG)
Is there an Intrauterine<unk> ?
If there is an IUP and there was no assisted reproductive fertility used then<unk>  ruled out and heterotopic unlikely (less than 1:30,000)
If fertility assistance was used then still consider a heterotopic (1% risk)
If HCG above Discriminatory Zone (>1,500-3,000 mIU/ml) and not visualized it should be an<unk>  until proven otherwise
Arrange close follow-up for patients with no visualized IUP and B-HCG( (<1,500-3,000 mIU/ml), with minimal to no pain and hemodynamically stable.
Patients should have a 48hr repeat B-HCG level checked to determine if appropriate doubling is occurring.
Increase >53% in 48hrs (until 10,000 mIU/ml)
Depends on the initial value:
<1500 --> 50% increase
1500-3000 --> 40% increase
> 3000 --> 30% increase
<1500 --> 50% increase
1500-3000 --> 40% increase
> 3000 --> 30% increase
Increases or decreases slowly ("plateau")^
Decreases >20% in 48 hrs
^Initial level CANNOT be used to rule-out<unk>
Ectopic pregnancy
Ovarian torsion
Subchorionic hematoma
Tubo-ovarian abscess
First Trimester Abortion
Ovarian cyst
Complete Abortion
Endometriosis