A female has history of 6 weeks amenorrhoea, USG shows no sac, serum beta HCG-1000 IU/L. What would be the next step in management of the patient?
Medical management
Repeat HCG after 48 hours
Repeat HCG after 1 weeks
None of the above
In normal intrauterine pregnancy the level HCG doubles every 48 hours whereas in ectopic pregnancy the level of HCG shows a slow rise or it plateaus. Since the USG in this patient does not show a sac and the level of HCG is low its level should be repeated after 48 hours to exclude ectopic pregnancy. In normal pregnancy at 5-6 weeks of gestation, a gestational sac is visible on ultrasound. A beta-hCG level of 6500 mU/mL with an empty uterine cavity by transabdominal ultrasound is highly suspicious for an ectopic pregnancy. A beta-hCG value of 2000 mU/mL or more can be indicative of an ectopic pregnancy if no products of conception are detected within the uterine cavity by transvaginal ultrasound. Ref: Rogers V.L., Worley K.C. (2013). Chapter 19. Obstetrics & Obstetric Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment 2014.