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I do think Ruth nn Ruthie is adorable, and would be so sweet on a little girl. I'd totally use it, if it wasn't my grandma's name (I still want to honour her, but using her birthstone (Opal) instead, in the interest of avoiding World War 3 in my family and having to use a name I don't like. It's happened before. Plus, it's been done- my sisters midlle name is Ruth. My cousin Emily is also named after her)

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My Grandma is Ruth Emma, so Ruth Emily and Ruth Emmaline made me smile.

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Ruth Adeline and Ruth Emmaline are both really nice. I like Keturah, but it sounds awkward paired with Ruth, as does Emily.

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Other ides:
Ruth Adelaide
Ruth Esther
Ruth Louisa
Ruth Eloise / Eloisa
Ruth Vivienne
Ruth Jemima
Ruth Anneliese
Ruth Anastasia
Ruth Hermione
Ruth Cecily
Ruth Verity
Ruth Evangeline
Ruth Elizabeth
Ruth Genevieve
Ruth Sophia
Ruth Keziah