levels on serial measurement or an increase of less than 66% in 48 hours suggests a nonviable fetus Septic abortion may complicate an intrauterine infection from a spontaneous abortion or from an induced abortion The patient may have signs of fever, severe pelvic pain, and leukocytosis Retained products of conception may still be present and will require surgical evacuation Broad-spectrum parenteral antibiotics should be initiated to cover for gram-positive and gram-negative bacteria Infections may also occur from polymicrobial organisms, anaerobic bacteria, and fungi Consultation with a specialist is imperative Bleeding During an Ectopic Pregnancy An ectopic pregnancy is a pregnancy that is not intrauterine Nearly all ectopic pregnancies occur in the fallopian tubes Adolescents who have had pelvic inflammatory disease, tubal surgeries, or previous ectopic pregnancies are at risk of having ectopic pregnancy, though many patients with ectopic pregnancy will present with no risk factors Sharp pain, lateralized pain, and pain of moderate to severe intensity favor ectopic pregnancy Examination findings that favor ectopic pregnancy include cervical motion tenderness, lateral pelvic tenderness, and signs of peritoneal irritation β-hCG levels may be low compared to an intrauterine pregnancy of the same gestational age If an intrauterine pregnancy is not seen on ultrasound, a transvaginal ultrasound should be performed to look for an ectopic pregnancy Sonographic signs suggestive of ectopic pregnancy include a solid or complex adnexal mass, a pelvic mass, particulate fluid in the fallopian tube, an endometrial pseudogestational sac, and cul-de-sac fluid that is either moderate to large in volume or echogenic Ultrasound and serial β-hCG testing are the main diagnostic studies for ectopic pregnancy, though in rare circumstances obtaining a serum progesterone concentration may be helpful; serum progesterone levels are usually higher in intrauterine pregnancies than in ectopic and nonviable pregnancies If an ectopic pregnancy is diagnosed, an obstetrician/gynecologist or other appropriate surgical service should be called to manage the patient The mainstay of treatment is surgery, though early ectopic pregnancies may be managed medically with the administration of methotrexate Patients who present with ruptured ectopic pregnancy must be monitored closely for signs of hemodynamic instability, sepsis, and shock in the hospital Bleeding During Late Pregnancy If the patient is 20 weeks pregnant or more by history or abdominal examination, potential causes of bleeding that must be identified urgently are placenta previa (placenta close to or overlying cervical os), abruptio placentae (premature