A female has history of 6 weeks amenorrhea, USG shows empty sac, serum 13 hCG 6500IU/L. would he next mannee.ment:
Ans. is a i.e. Medical Managemet Now, this is a tricky question. Patient is presenting with? - Amenorrhea of 6 weeks - Absence of gestation at Sac in uterus. - /311CG levels 6500 MIU/ml It is impoant to note that value of PHCG is 6500 MIU/ml--much high above the discriminatory zone (1500 MIU/ ml)and still gestational sac is not visualised. The diagnosis goes more in our of Ectopic pregnancy because values of phCG are very high -- In case of failed intrauterine pregnancy -- at this high level of IihCG, either the dead fetus or the Yolk Sac etc. would have been visible (if the case was of missed aboion) or patient would have given history of bleeding and passage of product of conception (if it would have been a case of complete aboion --) then only the gestational sac can be empty).But here is no such history. So the chances of ectopic pregnancy are more. But since, this option is not given so I will directly do medical management in this case. If there is any doubt -- see the following flow cha given both in williams obs and gynae--which clearly shows-- if the value of phCG is more than the discriminatory zone then either a D&C should be done or ectopic should be managed straight away.
Medical management
Repeat hCG after 48 hrs
Repeat hCG after 1weeks
Surgical management