Laboratory Studies
The following laboratory studies may be included in the workup:
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Complete blood count and platelets: Repeat H&Hs may be helpful in assessing the degree of ongoing hemorrhage.
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Complete metabolic panel
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Beta-human chorionic gonadotropin level: A quantitative level may provide useful information and a basis for future comparison.
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Prothrombin time/activated partial thromboplastin time
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Urinalysis
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Blood type and screen or type and cross with antibody screen (with severe hemorrhage)
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If DIC is suspected, fibrinogen, fibrin split products, and D-dimer should be obtained.
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Erythrocyte sedimentation rate may be helpful in assessing developing infection.
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Endocervical cultures (eg, aerobic, anaerobic, gonorrheal, chlamydial) and Gram stain may be indicated.
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Blood cultures should be obtained if the patient is febrile and systemic infection is suspected.
Imaging Studies
To exclude free air as a result of bowel perforation, obtain either an upright chest radiograph or an upright abdominal radiograph. Both supine and upright radiographs of the abdomen assist in the detection of free air or foreign bodies.
Perform ultrasonography with a vaginal probe to rule out ectopic pregnancy, retained products of conception in the uterus, adnexal masses, free fluid in the cul-de-sac, and hematometra.
Abdominal and pelvic CT may be useful in evaluating the acutely tender abdomen and pelvis if pelvic ultrasonography is not diagnostic.
Obtain arteriography if injury to the large blood vessels is suspected.
