Question

A female patient presents to you with six weeks of amenorrhea, associated with abdominal pain and vaginal bleeding with normal blood pressure. Investigations revealed beta – hCG to be 1400 mIU/mL. An ultrasound scan was done which showed a trilaminar endometrium with normal adnexa. What is the next best step in the management of this patient ? 

• A. Repeat beta – hCG after 48 hours
• B. Repeat ultrasound after 3 days
• C. Measurement of progesterone
• D. Laparoscopy

Answer 1

The Correct Option is A

A female patient presents with six weeks of amenorrhea, abdominal pain, and vaginal bleeding. Her beta-hCG level is 1400 mIU/mL, and ultrasound shows a trilaminar endometrium with normal adnexa. The concern in such a scenario is an early intrauterine pregnancy versus an ectopic pregnancy. Since the ultrasound does not show an intrauterine pregnancy yet, and beta-hCG is below the discriminatory zone (usually around 1500-2000 mIU/mL), the best approach is to monitor the beta-hCG levels for changes indicating a normal progressing pregnancy, a miscarriage, or an ectopic pregnancy.

The next best step is to repeat beta-hCG after 48 hours. In a normal, viable intrauterine pregnancy, hCG levels should approximately double every 48-72 hours. In the case of an ectopic pregnancy or a failing pregnancy, the increase will be slower, or levels may plateau or decrease. This approach allows for further clarification of the situation and guides definitive management.