The goal of this study is to learn if the ROM-Plus bedside test can effectively triage patients who present with pregnancy of unknown location (PUL) and vaginal bleeding as high or low risk for ectopic pregnancy. The main question to answer is:

Can the ROM-Plus bedside test effectively risk-stratify patients who present with PUL and vaginal bleeding as high or low risk for ectopic pregnancy after a single clinical encounter.

Participants will have a vaginal swab collected at the time of presentation.

Pregnancy of unknown location (PUL) is a clinical scenario in which a patient has cramping or vaginal bleeding and is known to be pregnant based on physical and laboratory evaluations, but an intrauterine or extrauterine pregnancy cannot be visualized on ultrasound examination. At present, follow-up for these patients includes multiple blood draws and repeat ultrasounds to confirm if the pregnancy is inside the uterus or in a riskier location outside the uterus (ectopic pregnancy); however, most of these patients will be low-risk for ectopic pregnancy and do not need intensive follow-up. This study aims to improve the risk-stratification of PUL patients after a single encounter to allow for patients at low-risk for ectopic pregnancy to be discharged from intensive follow-up.

Recruitment: Up to 120 participants will be recruited for this study

Entry Criteria:

• PUL diagnosis in the UC Davis Emergency Department or Obstetrics and Gynecology Office
• Vaginal bleeding
• Clinically stable
• English-speaking

Consent - Eligible Patients will be invited to participate by a member of the clinical care team. Written consent will be required.

Confidentiality - The Principal Investigator will preserve the confidentiality of participants taking part in the study. All patient information will be stored on a secure computer with password protection. All information will be de-identified.

Conflict of interest - none

Inclusion Criteria:

• PUL diagnosis in the UC Davis Emergency Department or Obstetrics and Gynecology Office
• Vaginal bleeding
• Clinically stable
• English-speaking

We will prospectively follow patients who present to the Emergency Room or OBGYN clinic and are diagnosed with PUL. In this clinical trial, we will include patients who present with PUL, have vaginal bleeding, and are clinically stable. Patients will be excluded if they have a definitive diagnosis on initial presentation, have an incidental pregnancy identified, or present with cramping only.