A 30-year old woman has irregular menses. She reports that her last menstrual period (LMP) was 8 weeks ago. She has been experiencing vaginal spotting and left lower quadrant pain. She is afebrile. She has a normal size uterus and mild tenderness in the right lower quadrant with no rebound tenderness. A human chorionic gonadotropin (hCG) beta-subunit level of 1400 mIU/ml is reported in her records from an obstetrics visit 2 days ago. Which of the following is the appropriate management?
A. Perform a pelvis ultrasound
B. Perform a culdocentesis
C. Repeat hCG measurement in 1 week
D. Repeat hCG measurement in 24 hours
E. Refer for diagnostic laparoscopy
c or d....i think cccc
u need atleast 1500 for TVU and 6500 for pelvicUSG
d..
but uw says that can see iup by pelvic usg even if bhcg <1500 so in that case has to be a .
but still think dd.
The correct answer is D. This patient has irregular menses and an associated low hCG level. She may have a normal intrauterine gestation, with an associated corpus luteum cyst causing the left lower quadrant pain, a threatened abortion or an ectopic pregnancy. It is recommended to repeat the hCG assay in 24 hours to see if it is rising appropriately.
A pelvis ultrasound (choice A) would not be helpful in detecting the gestational sac since its sensitivity begins at 1500 mIU/ml for a vaginal ultrasound.
Culdocentesis (choice B) is an invasive procedure to be used after more information is obtained.
Repeating hCG in 1 week (choice C) may miss an ectopic pregnancy leading to tubal rupture and hemorrhage.
Diagnostic laparoscopy (choice E) would be too invasive an option at this time.
oh k got pelvic usg n tvusg messed up
sugur!....got confused...right....tx!