Critical Issues in the Initial Evaluation and Management of Patients Presenting to the Emergency Department in Early Pregnancy

Official 2016 guideline from the American College of Emergency Physicians.

Strength

Recommendations

Diagnosis

Level B

Perform or obtain a pelvic ultrasound for symptomatic pregnant patients with any β-human chorionic gonadotropin (β-hCG) level.

Level B

Do not use the β-human chorionic gonadotropin (β-hCG) value to exclude the diagnosis of ectopic pregnancy in patients who have an indeterminate ultrasound result.

Level C

Obtain specialty consultation or arrange close outpatient follow-up for all patients with an indeterminate pelvic ultrasound result.

Literature

Original/Primary Reference

Hahn SA, Promes SB, Brown MD. American College of Emergency Physicians. Clinical Policy: Critical Issues in the Initial Evaluation and Management of Patients Presenting to the Emergency Department in Early Pregnancy. Ann Emerg Med. 2017;69(2):241-250.

Summary By

Eric Steinberg, DO, MEHP

What do the ratings mean?

Level A

Generally accepted principles for patient care that reflect a high degree of clinical certainty (eg, based on evidence from 1 or more Class of Evidence I or multiple Class of Evidence II studies).

Level B

Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate clinical certainty (eg, based on evidence from 1 or more Class of Evidence II studies or strong consensus of Class of Evidence III studies).

Level C

Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of any adequate published literature, based on expert consensus. In instances where consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.