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b 37. Which of the following is the most reliable indicator of Ectopic gestation a.No gestational sac in USG b.Arias Stella reaction c.Culdo centesis showing blood in the posterior cul-de-sac d.Absence of the normal doubling of hCG levels


"c"... provided there is an accompanying positive pregnancy test....but that would be in case of a "ruptured" ectopic pregnancy.Maybe I am reading too much into the could also be "a".confused




a i go for this because ultra sound is the best technique to diagnose an ectopic


b? i would go for a if it is no INTRAUTERINE gestationalsac on ultrasound


A is the correct answer.



But I did quite a few C in the ER to confirm ectopic

Also d is used in the out-patient OB clinic

You will still do C if a woman comes in with right adnexal pain, beta-HCG positive and they come at night and believe it or NOT, you can not get an ultrasound at 11 p.m. or 2 a.m. to confirm no gestation sac, so you put a needle in the posterior culdo sac.

Hope you don't have to read too long and get ready to "JUST DO IT"

Thanks !


I never use beta HCG doubling time every 2 days as diagnopstic to rule out ectopic


You can not tell the patient I don't know what you got, come back in 2 days and get a blood test, and another 2 days , and another 2 days.

I don't think you.

In early stage of pregnancy, the beta-HCG will double every 2 days but is feasible practically to tll patient to come back every 2 days to have blood work done !

Got you !nodshaking head


It is NOT feasible to tell patient to come back every two days to check the beta HCG !

So D is not practical and unreasonable on an out-patietn basis


missed abortion too causes Absence of the normal doubling of hCG levels , right? so it isn't the best choice when looking for an ectopic. smiling face am I right?



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