A 32-year-old female, gravida 2, para 1, presents to the emergency department for evaluation of acute-onset low abdominal pain that began several hours ago. Her last menstrual period was approximately six weeks ago and her urine pregnancy test in the emergency department is positive. She denies gastrointestinal symptoms, dizziness, or fever. Her past obstetric history is significant for one uncomplicated normal spontaneous vaginal delivery three years ago. Her past medical history is significant for chlamydia diagnosed and treated in the last year and endometriosis. Her past surgical history is significant for diagnostic laparoscopy.

A 24-year-old gravida 2, para 1001 with a last menstrual period eight weeks ago presents to the emergency department complaining of vaginal spotting and cramping pain for the past three days that is increasing in intensity. She took a pregnancy test two weeks ago that was positive. She denies any significant past medical or surgical history, is not currently taking any medications and has no known medication allergies.

A 31-year-old gravida 3, para 1011 at 7 weeks’ gestation presents with vaginal spotting. She complains of no pain but reports mild uterine cramping. Her obstetric history is notable for a term cesarean delivery two years ago for non-reassuring fetal heart tones. Her first pregnancy was a fallopian tube ectopic pregnancy treated with methotrexate and complicated by a gastrointestinal hemorrhage. On review of systems, she reports nausea, vomiting, and fatigue. Her past medical history is significant for gastric ulcers and her past surgical history is significant for tonsillectomy. She is currently taking a proton pump inhibitor and prenatal vitamins. She has no known allergies.