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Beta HCG

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So how do we use the beta HCG when we're

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dealing with a pregnancy of unknown location?

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So we have the, you know, definitive ectopic, it's

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safe to treat, diagnose an IUP, continue with normal

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pregnancy, and then the pregnancy of unknown location,

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whether we've got an increase or decreased beta HCG,

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and let's talk about what those are and how we get

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from these yellow and red boxes over to a green box.

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And again,

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this is gonna be with follow-up.

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There's something called the discriminatory

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level of beta HCG, and what is that?

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It is the value above which an intrauterine

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gestational sac is consistently seen

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on ultrasound in normal pregnancy.

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So above this level, you should see,

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theoretically, an intrauterine gestational

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sac, and the consensus conference

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uh, decided that this discriminatory level

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should be increased from 2000 to 3000, but

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over 2000, it wasn't that the most likely

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diagnosis was an ectopic or even a viable IUP.

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The most likely diagnosis is

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actually a non-viable IUP.

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What does this mean, and

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how does it help or not help us?

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The actual likelihoods based on beta HCG, between 2000

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and 3000 of having a viable IUP is about 2%. Over 3000,

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it's only 0.5%.

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So this comes back to we have

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a pregnancy of uncertain

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location and we have these elevated HCGs.

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So the question is, is there a chance of a viable IUP?

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This is one of the questions we posed

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early on, and the answer to that

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question is, yes, there is a chance.

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So in order to be safe, it is really

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not ideal to treat for ectopic.

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So we do need to follow these up.

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So I'm actually gonna take that,

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and change it from yellow to red.

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Not safe to treat, even though we've got an

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elevated HCG, and we're gonna talk about why.

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So again, there's a small but real chance

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of harming a normal intrauterine pregnancy.

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The most likely diagnosis is not

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ectopic, but rather non-viable IUP.

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And there's a chance of a viable IUP. Assuming

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the patient's hemodynamically stable,

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there's generally very minimal

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risk in waiting to treat.

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And the beta HCG over 48 hours

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can provide valuable information.

Report

Faculty

Tony Filly, MD

Chair of Medicine

Community Hospital of the Monterey Peninsula

Tags

Women's Health

Uterus

Ultrasound

Obstetrics

Gynecologic (GYN)

Congenital

Body

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