Your patient is a well appearing, otherwise healthy 22 year old female who presents with lower abdominal pain x3 days. She is unsure of her LMP, but thinks she had some spotting about a month ago. Vital signs: Temp 99.3F, HR 92, BP 102/70, RR 20, 98% on RA. She has a benign, non-gravid abdomen. Urine pregnancy is positive. You fire off a quantitative hCG and don’t expect that result to come back for a while. What do you do next?

ACEP recommends (Level C recommendation) obtaining a diagnostic pelvic ultrasound regardless of the beta hCG level in a symptomatic pregnant patient, even though you may not definitively see an IUP. Other secondary findings on ultrasound, such as increased amounts of free fluid, can suggest the diagnosis of ectopic pregnancy. Pelvic ultrasounds can be acquired both trans-vaginally (TV) and trans-abdominally (TA). The threshold for detecting an IUP is 5-6 weeks by TV ultrasound and 6-7 weeks by TA ultrasound.