Negative ultrasound

a. An EP is very likely in the absence of an intrauterine pregnancy on TVS when the serum beta-hCG concentration is greater than 1500 IU/L. The next step is to confirm the diagnostic impression by repeating the TVS examination and beta-hCG concentration two days later. The diagnosis of EP is certain at this time if an intrauterine pregnancy is not observed on TVS and the serum beta-hCG concentration is increasing or plateaued. Treatment of EP should be initiated.

b. A falling beta-hCG concentration is most consistent with a failed pregnancy (eg, arrested pregnancy, blighted ovum, tubal abortion, spontaneously resolving EP). Weekly beta-hCG concentrations should be monitored until the result is negative for pregnancy.

B. Beta-hCG concentration greater than 1500 IU/L and an adnexal mass. An extrauterine pregnancy is almost certain when the serum beta-hCG concentration is greater than 1500 IU/L, a nonspecific adnexal mass is present, and no intrauterine pregnancy is observed on TVS. Treatment of EP should be initiated.

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