Impact of Urgent Care Point-of-Care Ultrasound for Early Pregnancy Complaints

For patients presenting to the emergency department (ED) or urgent care (UC) with early pregnancy complaints, intrauterine pregnancy (IUP) confirmation is essential in assessing risk for ectopic pregnancy. While point-of-care ultrasound (POCUS) is commonly used in the ED, it is less commonly used in UCs, leading to patient transfers to the ED, delayed diagnosis, and higher healthcare costs. We evaluated the safety and efficacy of an UC-based POCUS program primarily performed by Advanced Practice Providers (APPs) with physician review.

This is a retrospective cohort study of patients receiving UC pregnancy POCUS at a single UC site from February 2021 to August 2025. Physicians or APPs performed transabdominal and/or transvaginal POCUS. The primary outcome was ED transfers. Secondary outcomes were missed ectopic pregnancies and 30-day return visits. Categorical outcomes were analyzed with chi-squared testing, with ɑ = 0.05.

We reviewed 945 UC visits with pregnancy POCUS. APPs performed 593/939 (63.2%) of studies. The majority of patients (702/945, 74.3%) were discharged home. 238/945 (25.2%) were transferred to the ED (230) or clinic (8). On UC POCUS, 548 patients (58.5%) had confirmed IUPs, 389 (41.5%) had no definitive IUP. The presence of an IUP was associated with higher likelihood of discharge home (p< 0.0001). Compared to transfer, discharge from UC was not associated with higher likelihood of 30-day return (p= 0.92). No cases of missed ectopic pregnancy were identified in patients with confirmed IUP on UC POCUS.

In the largest UC-POCUS data set to date, the implementation of a POCUS program at a single UC led to 702 fewer ED transfers for pregnancy complaints over 4.5 years. 30-day return visits rates were similar between discharged and transferred patients, and no ectopic pregnancies were missed in 548 POCUS-confirmed IUPs, supporting the safety of this practice. These data suggest that an UC APP group equipped with POCUS can reduce ED utilization and health care costs for early pregnancy evaluations.