Bleeding or pelvic pain in early pregnancy (ectopic pregnancy, miscarriage)

Laboratory tests

• Serum quantitative β-hCG (do the following assays in the same laboratory)
• ABO and RhD blood groupif neededGestation of 12 weeks or more, blood group unknown: in an RhD-negative woman, NICE proposes anti-D between 12 weeks and 12 weeks + 6 days when a miscarriage or ectopic pregnancy is being treated, and considers it in case of heavy or repeated bleeding ^[2]; before 12 weeks, the CNGOF recommends not injecting it ^[3].
• Irregular antibody screen (RAI) (gestation ≥ 12 weeks of gestation, if not done during pregnancy follow-up)if neededGestation of 12 weeks or more, blood group unknown: in an RhD-negative woman, NICE proposes anti-D between 12 weeks and 12 weeks + 6 days when a miscarriage or ectopic pregnancy is being treated, and considers it in case of heavy or repeated bleeding ^[2]; before 12 weeks, the CNGOF recommends not injecting it ^[3].
• Pelvic ultrasound, transvaginal if in doubt (not a laboratory test), the same day if pain.

Laboratory tests (first assay)

• Serum quantitative β-hCG

48 hours later (not before), same laboratory

• Serum quantitative β-hCG (same laboratory, same method)

After methotrexate: on day 4 and day 7

• Serum quantitative β-hCG

Then once a week until negative

• Serum quantitative β-hCG
• After salpingotomy: one assay on day 7, then one a week until negative.
• After salpingectomy: urine pregnancy test at 3 weeks, no blood assay.

3 weeks after the miscarriage

• Urine pregnancy test at home (no laboratory test).
• No routine laboratory tests after one or two early miscarriages.