Diagnosing Ectopic (Tubal) Pregnancy With hCG Levels


How can a woman know if she has an ectopic pregnancy? What should be done about it?

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Ectopic pregnancy

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A low or slow-rising hCG level can be a sign of an ectopic pregnancy, but looking at hCG levels alone is not usually enough for a doctor to make the diagnosis. While a slow-rising or low hCG level can indicate an ectopic pregnancy, it does not mean that you are definitely experiencing one. There are other reasons for slow-rising hCG levels. If the pregnancy cannot be visualized at all, the pregnancy might be ectopic, depending on the hCG levels. If the hCG levels are above 1,800 and the embryo cannot be visualized in the womb, the suspicion for an ectopic pregnancy increases dramatically.

Normal vs. Slow Rising hCG. Beta human chorionic gonadotropin (β-hCG) can be detected in pregnancy as early as eight days after ovulation.14The rate of increase in β-hCG levels, typically measured every 48 hours, can aid in. In early pregnancy, an increase in serum hCG of less than a minimal threshold in 48 hours is suspicious of an abnormal pregnancy (ectopic or early pregnancy loss) because 99% of normal intrauterine pregnancies will have a rate of increase faster than this minimum. Laboratory decoding of hCG in ectopic pregnancy according to the results of a blood test is considered the most accurate and reliable.

It shows an increase in the level of this hormone 4 days after fertilization and even earlier. The level of hCG in the blood during normal pregnancy is more than 15 mIU / ml. The great diagnostic value of serum beta-HCG is emphasized in the cases of old disturbed ectopic pregnancies accompanied by mild and uncommon symptoms and very low beta-HCG levels.

In case of unruptured pregnancies or tubal rupture the diagnosis is verified before the result is available by the clinical and sonographic data. The first and most useful basic test for diagnosing an ectopic pregnancy is a urinary pregnancy test. Because these tests are reliant on the hormone Human Chorionic Gonadotropin (hCG), a hormone produced by a fertilised egg after conception, these can sometimes produce a false negative result because the hormone is not present in high enough levels to test positively. 439 rows · Jan 11, 2020 · According to this review, serum CPK level can be used as a diagnostic. Diagnosis of ectopic pregnancy.

Although much is made of blood hCG levels and ultrasound studies, the clinical impression of the gynecologist or reproductive endocrinologist is the most important factor in making a timely diagnosis of ectopic pregnancy. There is no significant difference in the morphology of ectopic pregnancy between the two patterns of β hCG clearance. In group 1 the average half life of β hCG clearance was 82.5 hours (±SD 50.2).

In group 2 the average half life of β hCG clearance, in the decline phase of the curve, was 106.7 hours (±SD 72.0).

List of related literature:

A plateauing of hCG is consistent with an ectopic gestation or abnormal intrauterine pregnancy.

“Textbook of Family Medicine E-Book” by Robert E. Rakel
from Textbook of Family Medicine E-Book
by Robert E. Rakel
Elsevier Health Sciences, 2007

The patient with an ectopic pregnancy has elevated hCG levels signifying the presence of a pregnancy; however, the hCG level does not double in 48 hours as in most normal early uterine pregnancies.

“Crush Step 1 E-Book: The Ultimate USMLE Step 1 Review” by Theodore X. O'Connell, Ryan Pedigo, Thomas Blair
from Crush Step 1 E-Book: The Ultimate USMLE Step 1 Review
by Theodore X. O’Connell, Ryan Pedigo, Thomas Blair
Elsevier Health Sciences, 2017

Failure of the hCG concentrations to increase appropriately may indicate an abnormal implantation such as an ectopic (tubal) pregnancy or a non-viable intrauterine gestation.

“The Reproductive System at a Glance” by Linda J. Heffner, Danny J. Schust
from The Reproductive System at a Glance
by Linda J. Heffner, Danny J. Schust
Wiley, 2010

If levels of hCG in the blood do not rise by 66 percent to 100 percent after 48 hours, then an abnormal pregnancy (either ectopic or potential miscarriage) is suspected.

“The New Harvard Guide to Women's Health” by Karen J. Carlson, Stephanie A. Eisenstat, Stephanie A. Eisenstat, M.D., Terra Diane Ziporyn, Alvin & Nancy Baird Library Fund, Harvard University. Press
from The New Harvard Guide to Women’s Health
by Karen J. Carlson, Stephanie A. Eisenstat, et. al.
Harvard University Press, 2004

Ectopic pregnancies demonstrate an abnormal rise in serial hCG levels.

“Sonography Exam Review: Physics, Abdomen, Obstetrics and Gynecology E-Book” by Susanna Ovel
from Sonography Exam Review: Physics, Abdomen, Obstetrics and Gynecology E-Book
by Susanna Ovel
Elsevier Health Sciences, 2019

This phenomenon, caused by heterophilic serum antibodies, produces false-positive hCG levels usually less than 1000 IU/L. The sonographic identification of an intrauterine gestational sac essentially excludes an ectopic pregnancy.

“Conn's Current Therapy 2010 E-Book: Expert Consult” by Edward T. Bope, Robert E. Rakel, Rick D. Kellerman
from Conn’s Current Therapy 2010 E-Book: Expert Consult
by Edward T. Bope, Robert E. Rakel, Rick D. Kellerman
Elsevier Health Sciences, 2010

n n About 85% of women with an ectopic pregnancy have serum HCG levels lower than in normal pregnancy; the normal HCG doubling time is 1.4 to 3 days in early n pregnancy.

“Comprehensive Gynecology E-Book” by Rogerio A. Lobo, David M Gershenson, Gretchen M Lentz, Fidel A Valea
from Comprehensive Gynecology E-Book
by Rogerio A. Lobo, David M Gershenson, et. al.
Elsevier Health Sciences, 2016

hCG levels are elevated in multiple and molar pregnancies and low with ectopic pregnancy or abnormal placentation (Liu, 2004).

“Perinatal Nursing” by Kathleen Rice Simpson, Patricia A. Creehan, Association of Women's Health, Obstetric, and Neonatal Nurses
from Perinatal Nursing
by Kathleen Rice Simpson, Patricia A. Creehan, Association of Women’s Health, Obstetric, and Neonatal Nurses
Wolters Kluwer Health/Lippincott Williams & Wilkins, 2008

The diagnosis of early ectopic pregnancy is facilitated by quantitative hCG testing and transvaginal ultrasonography.

“Hacker & Moore's Essentials of Obstetrics and Gynecology E-Book” by Neville F. Hacker, Joseph C. Gambone, Calvin J. Hobel
from Hacker & Moore’s Essentials of Obstetrics and Gynecology E-Book
by Neville F. Hacker, Joseph C. Gambone, Calvin J. Hobel
Elsevier Health Sciences, 2009

The rise in hCG levels is abnormal in ectopic pregnancy.

“Manual of Obstetrics E-book” by Daftary, SUDIP Chakravarti, Muralidhar Pai, Prahalad Kushtagi
from Manual of Obstetrics E-book
by Daftary, SUDIP Chakravarti, et. al.
Elsevier Health Sciences, 2015

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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  • excelent! just to add(as some examiners might argue that) IUCD increases the risk of ectopic AS IT INCREASES risk of PID….(otherwise studies have shown that IUCD actually decreases risk of ectopic pregnancy when compared with patients not using any method of contraception )

  • This is very helpful and I know hcg levels differ between woman to woman and each pregnancy….
    You give me hope because my hcg is high and slowly rising, and gestational sac about 4-5 was along….
    I might wait a couple weeks and schedule an actual obgyn appointment.
    The lady at the clinic didn’t exactly seem to know the answers to my questions and referring me to an actual doctor.
    Definitely waiting because American doctors tend to be rushy and might end scheduling a dnc and such without giving much time….
    Definitely have hope.
    If not a pregnancy, Definitely going to try, try again.

  • So sorry for what you are going through. I suffered an ectopic pregnancy myself that they only found after weeks of tests and I was bleeding heavily. I had hoped it would be a pregnancy until they eventually found it and then it was a rush to get it out of me. What I will say is that even though you know it is going nowhere, you still need to grieve whilst going through it. I was 9 weeks before I had the injections to get rid of the ectopic so know what you are feeling with it going on and on.

    I bleed for about 6 weeks post the injections for the ectopic in my tube but then I went on to have a normal pregnancy and my youngest. You always worry next time you fall pregnant but they do test you regularly to check everything is going to plan.

    I hope this offers comfort to know all will be fine especially if it is an ectopic. Keeping you in my thoughts for the time ahead xx

  • I’m so sorry for everything you and your family are going through, your right you shouldn’t have to hide what is currently happening but also don’t feel you have to share anything you don’t feel ready or comfortable with. I really hope everything is ok. Xx

  • Hello there! Have you heard about Calmunt Unbelievable Pregnant Miracle (google it)? Ive heard some amazing things about it and my cousin got excellent results with it.

  • I’m a final year biomedical science student currently revising reproductive medicine and this lecture was so helpful and concise! Thank you for everything you do.

  • VGood day sir/madam…. I gone through ecotopic pregnancy open surgery on Jan 21 2019….before this surgery I had my successful first pregnancy with baby girl on 2016…… After ecotopic surgery every month I am getting ovalution pain on my left side( my left follopian tube is removed because it is ruptured)…. This month Jun 2019…I am getting pain on my right side….is it common ovalution pain r is it another ecotopic pregnancy?….plse reply me

  • Thank you osmosis for the content you provide!!!! As a current medical student, it makes studying so much easier!! And gets me out of tough situations during my clinical rotations! When I graduate I will give you a shout out in my graduation speech ������

  • My heart goes out to you, I hope you know what’s going on and I hope it’s a healthy pregnancy. Stay strong and try to be positive. You are a strong woman and you will get through it.

  • I have heard stories where a woman had an abdominal ectopic pregnancy(so the baby is outside the entire reproductive system) and the only difference between her pregnancy and a normal pregnancy was where the baby was on the ultrasound and she was actually able to give birth via abdominal surgery. I have also heard stories of stone babies, where a woman was pregnant for years before getting the calcified baby out via surgery.

  • Ugh, why am I doign this to myself. I know it’s educational to know this stuff, but…guh, my face is starting to turn green. ����

  • It should be an embryo instead of a shape of baby in the case of ectopic pregnancy.
    The videos of osmosis are really fantastic but not in this case.
    The shape of baby may lead to misunderstanding, and maybe rearrange the picture may be a good idea.

  • If, in 2 days, ß-hCG levels have increased less than 66%, the chance that the woman has an abnormal pregnancy is high (about 90% chance, with only about a 10% chance of having a normal pregnancy). In about a half of ectopic pregnancies, ß-hCG levels in fact decreases in a 2 day period.

  • Sir my first pregnancy is ectopic and my second pregnancy is same that it is ectopic can you explain me why again and again my pregnancy is ectopic. I have only one tube

  • Your story is very inspiring as I’m going through something similar right now with my hcg not doubling in the time frame. I hope I have this same outcome. If you don’t mind sharing, what were your numbers?

  • This is what I’m going through. My numbers went from 648 to 926 over four days. Then from 926 to 1371 today. Extremely slow rising and I’m spotting. But the doc is hopeful. I’m just having a hard time being hopeful after having ten miscarriages.

  • Would the hospital send a woman home the same day if they diagnosed an ectopic pregnancy at 12 weeks? Thank you in advance for your reply.

  • How slow was your hcg around 6 weeks? My hcg only rose by 1000 in 48 hours and it’s currently around 6400. They have seen a heartbeat but I’m not so positive as I hear so many people with negative outcome. Is there any hope?

  • Nice video, I liked that in the DDx you mentioned the medical/surgical emergencies vs the other DDx to consider. I would perhaps add in that the most common location is in the ampulla of the FT. Also, RFs for ectopic pregnancy include PID, IUD, and previous ectopic pregnancies (strongest RF). Finally, one of the most significant SEs of MTX is hepatotoxicity, thus it is an additional exclusion criteria.

  • As per DC Dutta’s textbook of obstetricsthe incision line of salpingostomy is kept open to be healed later on by secondary intention.

  • Awwww yammy sending you the biggest of hugs,, your so strong and I’m so so sorry your going through this,, I suffered a miscarriage which got missed and it’s taken a long time to get my head round things. Xx

  • That is amazing. I couldn’t know how to describe it. Besides, i love the new typefont and summary full of images which is easier to remember. Overall i really appreciate it❤❤ Lots of loving from Turkey

  • We went through this in February, we tested positive on the 7th and had an ultrasound on the 14th and it was put down as a PUL also, they booked us in for a week later. I was around 5wks at the next scan and again they couldn’t confirm the viability or location of the pregnancy. We then went back 2 weeks later and saw a beautiful little jelly bean with a strong heartbeat. Don’t lose faith, I’m now 17weeks with our third baby. Xx

  • All your videos are really useful explanations keep it up. Check out my brand new channel on Mental Health. Your support is much appreciated:)

  • I had ectopic pregnancy as well end up with surgery 07.12.2019 now I am still sick. ���� was my 3 pregnant but other all 2 end up with miscarriage ������ I am 29years but I loose hope they remove my one tube.���� guys I am very sad

  • Thank you so so much!!!!!!!! I am in the same exact position my HCG level passed from 3000 to 50000 to 68000 and no yolk sac in the gestational sac at ) week.. I have another ultrasound Wednesday but I am going at my appointements not expected a baby even do I want that baby so bad!! You give me so much hope and I pray for a miracle xoxoxo

  • Where exactly will the pain m, like how far up or down. I am 13 weeks now but a pain has started today on my far right side and flank. I know this is not where my tubes are but I need to know what this pain could possibly be

  • Your story gives me such hope. I am going through exactly the same thing right now. And I am feeling the exact same things. I was told the exact same things. To see you end up having the baby. No 3 and not lose it gives me so much hope. I keep watching it again and again. I have low hcg levels not rising at a greater rate.

  • Found your video after over a week of searching for positive stories. Slow rising Hcg, PUL, hoping for a miracle on Friday for my next scan ���� thanks for sharing your story!!

  • Correction:u said salpingostomy is closed after surgery..its absolutely wrong..in salpingostomy,we make a linear incision,take the ectopic sac out n then this incision is left open, its not sutured back..in one to two days,there will be reepithialisation n it will thereby close by itself..wat u told is actually salpingotomy where incision is sutured after removal of ectopic sac

  • I’ve currently got a pregnancy In an unknown location at the minute

    The pain I’ve got sounds similar to yours, moves around it’s like hip, groin and sometimes no where if I’m in certain positions etc. Some days it hasn’t been there at all, I don’t know what to make of it.

    I had 3 blood tests every 48 hours
    Between 1800-2800 in 44 hours
    Then 2800 to 4700 in 48 hours.

    I’ve had two scans, one on 1800hcg and nothing seen at all, and at 4700 still nothing. Not even in the tubes…
    I have the free fluid too and it’s clear, so they think it’s from a cyst. It was there on both scans.
    They mentioned briefly about a corpus luteum. But never confirmed if that was actually seen or not. I’m still breastfeeding too, just morning and night…

    I’ll be back on Monday for another scan, if still nothing then I’ll be in for surgery!
    Thanks for sharing your story!

  • Hey i had my last period in 11September.. And i didn’t feel any symptoms accept the fact I miss my period.. I went toh the Dr and had an ultrasound on week6 and was the day before yesterday.. But they didn’t found the embryo on the machine.. So may be i have anembryonic pragnancy but i have done.. Beta hcg test and the level is 2575.0.. Is it normal plz help.. I will check on to my Dr tomorrow but i am really curious right now

  • Does Clegenatur Methods really work? I notice a lot of people keep on talking about Clegenatur Methods. But Im uncertain if it’s good enough to increase their breast size without surgery.

  • Hi I am 23, last week my pregnancy was confirmed. Went to doctor she suggested some medicine and told to scan on March 30. I am bit scared about ectopic pregnancy. I don’t have any bleeding I just have white discharge. Abdominal pain in middle and left side, headache. Is there any chance for ectopic pregnancy.

  • In early normal pregnancies, blood levels of ß-hCG double about every 2-3 days. Thus, if serial ß-hCG levels are measured, levels should double in two thirds of women with normal pregnancies in 2 days and in all women in 3 days.

  • I am going through this exact situation right now! The exact same symptoms as well. Pain on the right side, it’s literally like you are telling my story.

  • Excellent video! Thank you so much for making this topic clear. I would like to add chlamydia as risk factor specifically.
    This bacterium is notorious for causing ectopic pregnancies as these infections are often asymptomatic in women.
    grtz from Belgium

  • Nice vedeo….i am from india…i am herbalist docter….pls contine to make the vedeos like this….my humble requst to u that make vedeo on herbal medicin also….

  • Hi. I have been experiencing abdominal pain and stomach pain. I also have been feeling what I think are my ovaries, when I’m just sitting on the couch or laying in bed. Does this also qualify as ectopic pregnancy?? I’m very worried. I have an IUD.

  • I’m praying with you. I’m in the same situation right now. My hcg levels are slow rising with a gestational and yolk sac with no embryo

  • Hi I’m 2 months nt on my periods and everything on my body is fine, there are nor signs of pregnancy so is it normal 2 b like that.

  • Tfor those who are watching, the hcg level doubles in 48 hours in the first 6 weeks. The doctor mistakenly tells 48 hours in this video

  • Hi this month i had one and half day period generally it varies from 5 to 6 days…i am married…after one and half day i am suffering lower back pain and feeling very tired…tell me what i can do

  • If at all possible, could you do a presentation on Mc or Microchimerism? I find the concept fascinating, however, their is an abundance of contradictory data extant.

  • I’ve heard of cases where because the egg moves from the ovary to the abdominal cavity, the mom goes to full term as normal, but then needs surgery for the birth. I’ve also heard of a case where a woman’s uterus ruptured, and then healed leading to there being 1 twin outside the uterus and 1 inside the uterus. The first one would be an Abdominal Ectopic Pregnancy, I know that. But the case of uterine rupture leading to 1 twin being outside the uterus after the uterus heals over, would that be a secondarily ectopic pregnancy since it started in the uterus and then was outside the uterus post-rupture?

  • My thoughts are definitely with you, you need some time to be with your family and yourself… I wouldn’t worry about updating people! You are so strong, one of the strongest women I know! I really hope everything turns out to be just fine. Sending my love x

  • Hi! I’m having an issue, when I have sex my right side hurts, like a stabbing pain. It hurts when I lay down and hurts when I pee ( just in the spot that’s around my ovary on the right) I’m not sure if it’s an ectopic pregnancy, PID, a cyst, or what. I know I have no stds I was recently checked at my 18 year old check up. I have the birth control implant as well.