A 25-year-old woman presents with 7 weeks amenorrhoea and mild left iliac fossa pain. Serum β-hCG is 1800 IU/L. Transvaginal ultrasound shows an empty uterine cavity without decidual reaction. At 48 hours β-hCG rises to 2400 IU/L (33% rise). Most appropriate management is:
- A Immediate laparoscopy for probable ectopic
- B Single-dose methotrexate 50 mg/m² IM
- C Repeat β-hCG at 72 hours before intervening ✓
- D Uterine evacuation to rule out pregnancy of unknown location
Correct answer: C. Repeat β-hCG at 72 hours before intervening
Explanation
With β-hCG below the discriminatory zone and a sub-optimal rise (< 35% in 48 hours) but no definitive ectopic seen on TVS, this is a pregnancy of unknown location (PUL) with at least one feature of ectopic. Management requires further β-hCG monitoring at 72 hours before definitive intervention. Methotrexate and laparoscopy are premature without confirmed ectopic; uterine evacuation risks missing a true ectopic.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.