Guideline sources The following summarized guidelines for the evaluation and management of early pregnancy are prepared by our editorial team based on guidelines from the American College of Emergency Physicians (ACEP 2017) and the Society of Obstetricians and Gynaecologists of Canada (SOGC 2014). 1 2 3 3 4 5 Definition Early pregnancy is a normal physiological event for a woman with a mean gestation period < 15 weeks (range of 6 to 24 weeks). 3 Epidemiology Early pregnancy is a result of conception either naturally or following medical intervention. 3 Disease course Clinical manifestations of early pregnancy include nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vulvar itching, varicose veins, pruritus, leg cramp, exhaustion, frequent coughs and colds, migraines, constipation, hemorrhoids, depression, anxiety, and vaginal bleeding. Vaginal bleeding may lead to spontaneous abortion. 4 Prognosis and risk of recurrence In the United States, mortality associated with legal induced abortion is < 1 per 100,000 procedures. 5 https://web.pathway.md/diseases/recPfjpwxzBnj6tIF 1/3 6/29/23, 4:14 AM Early pregnancy Pathway Guidelines 1. Diagnostic investigations Transabdominal ultrasound: consider first-trimester crown-rump length as the best parameter for determining gestational age and use whenever appropriate. B Dating ultrasound: consider using crown-rump length measurement from either transabdominal or transvaginal ultrasound to determine gestational age. Transvaginal ultrasound is not more accurate in determining gestational age than a transabdominal approach, although it may better visualize early embryonic structures. C 2. Specific circumstances Pregnant patients in the emergency department: Obtain a pelvic ultrasound for symptomatic pregnant patients with any b-hCG level. B Avoid using the b-hCG value to exclude the diagnosis of ectopic pregnancy in patients who have an indeterminate ultrasound result. D 3. Follow-up and surveillance Indications for specialist referral: obtain specialty consultation or arrange close outpatient follow-up for all patients with an indeterminate pelvic ultrasound result. B Serial imaging assessment: consider follow-up of interval growth 2 to 3 weeks following the ultrasound. Confirmation of an accurate due date is difficult when the assignment of gestational age is based on a third-trimester ultrasound. C Clinical findings Symptoms Neurological exam Abdominal pain Mood alteration Bloating Constipation Cramp Fatigue Missed menstrual periods Nausea Swollen breasts Urinary frequency Vomiting Lab findings urine urine -hCG https://web.pathway.md/diseases/recPfjpwxzBnj6tIF 2/3 6/29/23, 4:14 AM Early pregnancy Pathway References 1. Butt K, Lim K. Determination of gestational age by ultrasound. J Obstet Gynaecol Can. 2014 Feb;36 2 171 181. Open 2. Hahn SA, Promes SB, Brown MD. Clinical Policy: Critical Issues in the Initial Evaluation and Management of Patients Presenting to the Emergency Department in Early Pregnancy. Ann Emerg Med. 2017 Feb;69 2 241 250.e20. Open 3. Deirdre Gartland, Stephanie Brown, Susan Donath et al. Women's health in early pregnancy: findings from an Australian nulliparous cohort study. Aust N Z J Obstet Gynaecol. 2010 Oct;50 5 413 8. Open 4. Melissa C Lutterodt, Pernille K hler, Jakob Kragstrup et al. Examining to what extent pregnancy- related physical symptoms worry women in the first trimester of pregnancy: a cross-sectional study in general practice. BJGP Open. 2019 Dec; 3 4 bjgpopen19X101674. Open 5. Suzanne Zane, Andreea A Creanga, Cynthia J Berg et al. Abortion-Related Mortality in the United States: 1998 2010. 2015 Aug;126 2 258 265.2015 Aug;126 2 258 265. Open 6. Suzanne Zane, Andreea A. Creanga, Cynthia J. Berg et al. Abortion-Related Mortality in the United States 1998 2010. Obstet Gynecol. 2015 Aug; 126 2 258 265. Open 7. Liona C Poon, H David McIntyre, Jonathan A Hyett et al. The first-trimester of pregnancy A window of opportunity for prediction and prevention of pregnancy complications and future life. Diabetes Res Clin Pract. 2018 Nov;145 20 30. Open https://web.pathway.md/diseases/recPfjpwxzBnj6tIF 3/3