Oncology

Question 1

bhCG was below 1000. TVUS -> no pregnancy seen in uterus. What is the next step?

Answer 1

Repeat bHCG 48hrs later. USS repeated a week later.

An empty uterus can mean three things:
a complete miscarriage,
very early intrauterine pregnancy that is too small to visualize,
or an ectopic pregnancy.

If bhCG is >1000 iu a gestational sac should be seen on a transvaginal scan. If bhCG is <1000 iu it may be too early to visualize a gestational sac and serial bhCG
must be used. Serum bhCG should double in 48 hours in viable intrauterine pregnancies. A plateau of bhCG suggests ectopic pregnancy and a significant fall in bhCG suggests a miscarriage, however this is not always accurate. An ultrasound can be repeated in 1 week if the bhCG doubles and the patient remains well.