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  #1  
Old 10-30-2011
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ObGyn Vaginal spotting and positive pregnancy test!

A 22-year-old complains of vaginal spotting that began 37 days after her last menstrual period, and lasted 3 days. She denies any abdominal pain and states that her bleeding has now stopped completely. She had a positive home urine pregnancy test and you ordered a serum hCG (human chorionic gonadotropin) concentration earlier today, which returned as 432 mIU/mL. What should be the next step in your management of this patient?

(A) uterine curettage
(B) transvaginal ultrasound of the pelvis
(C) diagnostic laparoscopy
(D) hCG concentration in 24 hours
(E) hCG concentration in 48 hours

ps: guys can u please say why you picked ur answer as well... thanks...
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Old 10-30-2011
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(B) transvaginal ultrasound of the pelvis


may b to rule out an retained bits of placenta....instead of going with an instrumental procedure like curretage...
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b.........I have done this type of question somewhere.....
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Default the answer is E guys...

this was a tough one. but here's the answer:

(E) In normal intrauterine pregnancy, the serum hCG concentration should rise by at least 66% every 48 hours and often at least doubles. The hCG concentration will only rarely rise that fast in the case of ectopic pregnancy. In this patient who otherwise appears completely stable,
repeating the hCG level in 48 hours would be the best option. A normal intrauterine pregnancy will usually be visualized by transvaginal ultrasound when the hCG level approaches 15002000 mIU/mL. Performing the ultrasound now at this low hCG level will likely not localize
the pregnancy. Curettage should absolutely not be performed until there is clear evidence that this is an abnormal intrauterine pregnancy or
when hCG levels are not rising appropriately and ectopic pregnancy needs to be ruled out. Laparoscopy may be useful in this patient in the future, but first attempts should be made to localize the pregnancy with hCG levels and ultrasound. If her hCG level exceeds 2000 mIU/mL and the ultrasound is normal, laparoscopy would be the next step.
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Old 10-30-2011
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since im still around and plan on doing step 3 (and god knows whats going to happen to my step 2)

well in this case i suspect 2 things either an abortion OR spotting due to implantation and such which is also a common occurence. Since we already have a bHCG lvl today lets wait for 48 hours to see if it doubles as it will double every 48 hours in pregnany. If it doubles then we can say she is still pregnant and then follow uo in that direction, If it goes down then we suspect an abortion event and treat accordingly .
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Quote:
Originally Posted by docnas View Post
since im still around and plan on doing step 3 (and god knows whats going to happen to my step 2)

well in this case i suspect 2 things either an abortion OR spotting due to implantation and such which is also a common occurence. Since we already have a bHCG lvl today lets wait for 48 hours to see if it doubles as it will double every 48 hours in pregnany. If it doubles then we can say she is still pregnant and then follow uo in that direction, If it goes down then we suspect an abortion event and treat accordingly .
dude why didnt u give ur answer a tee wee earlier? ur explanation is so short and straight to the point!! i like it! thank u!!
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yeah i saw u had already posted the answer right after i finished posting mine but eh same thing u did cover all the major points but let me add one more thing

transvaginal US can see a uterine pregnancy when 1500 bHCG lvl while Transabdominal can only see it if over 6000 bHCG lvl .
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this was totally unexpected....i guessed it to be a complete abortion though the details of abortus were not mentioned....
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