A 24-year-old female presents with 6 weeks of amenorrhea, right lower quadrant pelvic pain, and vaginal spotting. Serum beta-hCG is 2,800 mIU/mL. Transvaginal ultrasound shows an empty uterine cavity and a 2.5 cm right adnexal mass without fetal cardiac activity. What is the diagnosis?
Answer and explanation
Correct answer: B. Tubal ectopic pregnancy
- Step 1: The discriminatory beta-hCG zone (typically 1,500-2,000 mIU/mL on transvaginal ultrasound) is the threshold above which an intrauterine gestational sac must be visualized.
- Step 2: A beta-hCG of 2,800 mIU/mL with an empty uterus and an adnexal mass confirms an ectopic pregnancy (most commonly in the fallopian tube ampulla).
- Step 3: Unruptured ectopic pregnancies meeting criteria may be managed with systemic methotrexate.
Answer
Tubal ectopic pregnancy.
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