Am Fam Physician. 2006 Apr 15;73(8):1331.
to the editor: I would like some clarification on a discrepancy I found between two articles in American Family Physician (AFP), “Management of Spontaneous Abortion”1 in the October 1, 2005, issue and “Diagnosis and Management of Ectopic Pregnancy”2 in the November 1, 2005, issue.
The authors of the article on spontaneous abortion1 use the Advanced Life Support in Obstetrics syllabus3 to substantiate the statement that, “When transvaginal ultrasonography reveals an empty uterus and the quantitative serum hCG [human chorionic gonadotropin] level is greater than 1,800 mIU per mL (1,800 IU per L), an ectopic pregnancy should be considered.”1
However, the article on ectopic pregnancy2 refers to a previous AFP article4 on ectopic pregnancy to support the statement that, “ectopic pregnancy is suspected…if transvaginal ultrasonography does not show an intrauterine gestational sac and the patient’s beta-hCG level is 1,500 mIU per mL (1,500 IU per L) or greater.”2
Thank you for any clarification you can provide on the current standard for this critical management issue.
1. Griebel CP, Halvorsen J, Golemon TB, Day AA. Management of spontaneous abortion. Am Fam Physician. 2005;72:1243–50.
2. Lozeau A, Potter B. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2005;72:1707–14.
3. Deutchman M, Eisinger S, Kelber M. First trimester pregnancy complications. In: ALSO: Advanced Life Support in Obstetrics course syllabus. 4th ed. Leawood, Kan.: American Academy of Family Physicians, 2000:1–27.
4. Tenore JL. Ectopic pregnancy. Am Fam Physician. 2000;61:1080–8.
in reply:We appreciate the opportunity to clarify the issue regarding the beta-human chorionic gonadotropin (beta-hCG) level above which a gestational sac can be visualized consistently with transvaginal ultrasound. The beta-hCG level at which we can visualize a gestational sac has decreased over time with advances in ultrasound technology. The article by the Advanced Life Support in Obstetrics (ALSO) syllabus refers to an article published in 1986.1 The recent literature regarding evaluation for possible ectopic pregnancy is consistent in recommending that, at a beta-hCG level of 1,500 mIU per mL (1,500 IU per L) or greater, the gestational sac should be visualized with transvaginal ultrasound.2–6 Our diagnostic strategy reflects this recommendation.
1. Nyberg DA, Filly RA, Filho DL, Laing FC, Mahony BS. Abnormal pregnancy: early diagnosis by US and serum chorionic gonadotropin levels. Radiology. 1986;158:393–6.
2. Tenore JL. Ectopic pregnancy. Am Fam Physician. 2000;61:1080–8.
3. Della-Giustina D, Denny M. Ectopic pregnancy. Emerg Med Clin North Am. 2003;21:565–84.
4. ACEP Clinical Policies Committee and Clinical Policies Subcommittee on Early Pregnancy. American College of Emergency Physicians. Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. Ann Emerg Med. 2003;41:123–33.
5. Barnhart K, Mennuti MT, Benjamin I, Jacobson S, Goodman D, Coutifaris C. Prompt diagnosis of ectopic pregnancy in an emergency department setting. Obstet Gynecol. 1994;84:1010–5.
6. Borrelli PT, Butler SA, Docherty SM, Staite EM, Borrelli AL, Iles RK. Human chorionic gonadotropin isoforms in the diagnosis of ectopic pregnancy. Clin Chem. 2003;49:2045–9.
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