0:00

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

0:04

dealing with a pregnancy of unknown location?

0:07

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

0:11

safe to treat, diagnose an IUP, continue with normal

0:14

pregnancy, and then the pregnancy of unknown location,

0:18

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

0:21

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

0:25

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

0:28

And again,

0:30

this is gonna be with follow-up.

0:32

There's something called the discriminatory

0:34

level of beta HCG, and what is that?

0:38

It is the value above which an intrauterine

0:42

gestational sac is consistently seen

0:45

on ultrasound in normal pregnancy.

0:47

So above this level, you should see,

0:51

theoretically, an intrauterine gestational

0:54

sac, and the consensus conference

0:57

uh, decided that this discriminatory level

1:00

should be increased from 2000 to 3000, but

1:07

over 2000, it wasn't that the most likely

1:11

diagnosis was an ectopic or even a viable IUP.

1:16

The most likely diagnosis is

1:17

actually a non-viable IUP.

1:23

What does this mean, and

1:24

how does it help or not help us?

1:28

The actual likelihoods based on beta HCG, between 2000

1:33

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

1:42

it's only 0.5%.

1:45

So this comes back to we have

1:46

a pregnancy of uncertain

1:49

location and we have these elevated HCGs.

1:53

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

1:57

This is one of the questions we posed

1:58

early on, and the answer to that

2:00

question is, yes, there is a chance.

2:03

So in order to be safe, it is really

2:08

not ideal to treat for ectopic.

2:10

So we do need to follow these up.

2:13

So I'm actually gonna take that,

2:16

and change it from yellow to red.

2:18

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

2:20

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

2:24

So again, there's a small but real chance

2:28

of harming a normal intrauterine pregnancy.

2:31

The most likely diagnosis is not

2:33

ectopic, but rather non-viable IUP.

2:36

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

2:39

the patient's hemodynamically stable,

2:41

there's generally very minimal

2:43

risk in waiting to treat.

2:46

And the beta HCG over 48 hours

2:48

can provide valuable information.