Question

A 20-year-old G1P0 woman has vaginal spotting and mild cramping for the last three days. She had her last normal menstrual period approximately seven weeks ago. She had a positive home pregnancy test. Vital signs are: blood pressure 120/72; pulse 64; respirations 18; temperature 98.6°F (37°C). On pelvic exam, she has scant old blood in the vagina, with a normal appearing cervix and no discharge. On bimanual exam, her uterus is nontender and small, and there are no adnexal masses palpable. Quantitative Beta-hCG 48 hours ago was 750 mIU/ml; today, current Beta-hCG 760 mIU/ml; progesterone 3.2 ng/ml; hematocrit 37. What is the most appropriate management for this patient?

1) Exploratory laparoscopy
2) Treat with methotrexate
3) Treat with mifepristone
4) Dilation and curettage
5) Repeat ultrasound in one week

Answer 1

The most appropriate management for this pregnant patient with abnormal Beta-hCG levels and progesterone would be to repeat the ultrasound in one week to monitor the progress of the pregnancy.

Step-by-step explanation:

The case presented describes a 20-year-old woman who is pregnant and experiencing mild symptoms that might suggest a range of conditions, including a normal pregnancy, ectopic pregnancy, or a miscarriage. The stable vital signs and lack of any adnexal masses or significant pain on examination seem reassuring, however, the lack of normal rise in Beta-hCG (human chorionic gonadotropin) over 48 hours and low progesterone levels are concerning and could suggest an abnormal pregnancy. A normal pregnancy should have a doubling of Beta-hCG approximately every 48-72 hours, and progesterone should be greater than 5 to 25 ng/ml to support a normal early pregnancy.

In managing this patient, the most appropriate step would be to repeat the ultrasound in one week unless her condition changes. This would allow for time to see if the pregnancy is progressing normally or if any changes suggest an abnormal pregnancy where interventions such as medical management or surgical options might be indicated.