Positive urinary pregnancy test

Transvaginal ultrasound scan

Expectant management

Consider laparoscopy or laparotomy

Serum human chorionic gonadotrophin (hCG)

Pregnancy of unknown location (PUL)

Haemodynamically stable Pain free

Haemodynamically stable Pain

Haemodynamically unstable Pain

End

Consider laparoscopy

Serum hCG levels at 0 and 48 hours

Initial level <1500 IU/L

Initial level >1500 IU/L

? Failing PUL

? Intrauterine pregnancy

? Ectopic pregnancy

>66% increase in serum hCG 0-48 hours

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

>15% decrease in serum hCG 0-8 hours

Repeat hCG now and 48 hours later

Management as clinically indicated

Rescan in 2 wk to confirm viability

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

Consider laparoscopy

>66% increase in serum hCG 0-48 hours

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

>15% decrease in serum hCG 0-8 hours

Repeat serum hCG in 1 wk to confirm failing

Consider weekly hCG monitoring until <15 IU/L