The backbone of this protocol is the systematic evaluation of the presentation, work up, diagnosis and treatment outcome of women who present for evaluation of pain or bleeding in the first trimester of pregnancy and are therefore at risk for ectopic pregnancy (EP). Our focus is women whose diagnosis was not definitive upon initial presentation. We plan to collect systematic data regarding the current diagnostic strategies and treatment of these women and compare actual outcomes to those predicted by our newly developed strategies. This will be the first time such an endeavor has been conducted at multiple centers concomitantly. Expansion to two other sites is vital to ensure our preliminary data is valid and generalizable to women from different races and ethnicities, as well as to achieve the precision necessary to develop an accurate clinical tool. We will use a secure web-based clinical database (the Quantbook) to compile clinical information, and will download de-identified data to the research database once the diagnosis and clinical course of a patient has been completed. The Quantbook will be an expansion of a clinical database successfully utilized at Penn for the past 15 years. For a more detailed description of the Quantbook and research databases please see Attachment 2 of the full protocol. High quality information obtained from this cohort of women will allow the optimization and validation of our currently derived and proposed methods of diagnosis.

Data Collection Clinical Database (Quantbook): The clinician (e.g., attending physician, fellow, resident physician, nurse practitioner) who assesses the patient input information into the Quantbook. At the first presentation, this will include the patient's medical history, as well as presenting signs and symptoms. Results of tests ordered, including hCG and relevant chemistry, hematology, blood type, and ultrasound, will be entered. The clinician will assign a clinical impression (which may be a final definitive diagnosis, or a suspected diagnosis, or "unable to determine"). Follow-up contacts and assessments are recorded as they occur. Each time the patient returns for an assessment, the clinical impression can be updated, until a definitive diagnosis is made. A research coodinator will be tasked to monitor the Quantbook to provide quality control that the clinical data entered is complete and correct.