Clinical Pearls

Levels of hCG that plateau in the first 8 weeks of pregnancy indicate an abnormal pregnancy, which may be either a miscarriage or an ectopic pregnancy.

The classic triad of ectopic pregnancy is amenorrhea, vaginal spotting. and abdominal pain.

When the quantitative hCG level exceeds 1500 to 2000 mlU/mL and the transvaginal sonogram does not show an intrauterine gestational sac, then the risk of ectopic pregnancy is high.


Mishell DR. Ectopic pregnancy. In: Stenchever MA. Droegemueller W. Herbst AL. Mishell DR. eds. Comprehensive gynecology. 4th ed. St. Louis: Mosby-Year Book. 2001:443478. Nelson AL. DeUgarte CM. Gambone JC. Ectopic pregnancy. In: Hacker NF. Moore JG. Gambone JC, eds. Essentials of obstetrics and gynecology. 4th ed. Philadelphia: Saunders. 2004:325-333.

A 29-year-old woman G2 PI at 28 weeks' gestation complains of fatigue of 1-week duration. Her antenatal history is unremarkable except for a urinary tract infection treated with an antibiotic 2 weeks ago. The patient also states that she has had dark-colored urine over the past week. On examination, her blood pressure is 100/60, heart rate 80 bpm, and temperature normal. The thyroid gland appears normal on palpation. Heart and lung examinations are unremarkable. Fundal height is 28 cm. Fetal heart tones range from 140 to 150 bpm. Her hemoglobin level is 7.0 g/dL.

^ What is the most likely diagnosis?

^ What is the underlying mechanism?

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