Positive urinary pregnancy test

Transvaginal ultrasound scan

Pregnancy of unknown location (PUL)

Consider laparoscopy or laparotomy

Serum human chorionic gonadotrophin (hCG)

Expectant management

Haemodynamically stable Pain free

Haemodynamically stable Pain

Haemodynamically unstable Pain

End

Consider laparoscopy

Serum hCG levels at 0 and 48 hr

? Failing PUL

? Intrauterine pregnancy

? Ectopic pregnancy

>66% increase in serum hCG 0-48 hr

<66% increase or <15% decrease in serum hCG 0-48 hr

>15% decrease in serum hCG 0-8 hr

Rescan in 2 wk to confirm viability

Management as clinically indicated

Repeat hCG now and 48 hr later

Rescan in 1 wk to confirm pregnancy location

Early intrauterine pregnancy visualized

Ectopic pregnancy visualized

PUL

If no pregnancy seen on repeat scan and suboptimal rise in hCG consider methotrexate

Repeat serum hCG in 1 wk to confirm failing

Consider weekly hCG monitoring until <15 IU/L

Initial level <1500 IU/L

Initial level >1500 IU/L

Consider laparoscopy

>66% increase in serum hCG 0-48 hr

<66% increase or <15% decrease in serum hCG 0-48 hr

>15% decrease in serum hCG 0-8 hr