First trimester bleeding occurs in up to 30% of all diagnosed pregnancies. Important causes of first trimester bleeding include spontaneous abortion, missed or threatened abortion, ectopic pregnancy, and gestational trophoblastic disease. One of the greatest dilemmas for clinicians is to accurately diagnose the cause of pain or bleeding, and specifically to determine if an ectopic pregnancy exists due to its grave consequences. Ectopic pregnancy occurs in almost two percent of all reported pregnancies in the United States and is the leading cause of pregnancy-related death in first trimester. When an early pregnant patient is identified who has bleeding or pain, it is crucial step to determine where the pregnancy is located. Ultrasound as a first line diagnostic tool offers an excellent opportunity for pregnancy localization. The use of the beta subunit of human chorionic gonadotropin (beta-hCG) quantification is a valuable adjunct to help determine the course and possible outcome of an early pregnancy. The goal should be to preserve the health and future reproductive capabilities of our patients.
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