Physical exam reveals the uterus to be about 6 wk size. Vaginal bleeding is scanty with no discernible tissue in the cervical os. There are no palpable adnexal masses. The uterus is mildly tender. Ultrasonographic exam does not reveal a gestational sac. Which of the following should be recommended?
a. Dilatation & curettage.
b. Culdocentesis.
c. Observation followed by serial B-HCG determinations.
d. Diagnostic laparoscopy.
e. Laparotomy
The correct answer is (c) Observation followed by serial B-HCG determinations.
The scenario suggests a possible miscarriage or failed pregnancy, but the ultrasound doesn’t show a gestational sac, and there’s no visible tissue in the cervical os. In this case, the recommended approach is to:
1. Observe the patient
2. Monitor serial beta-hCG (B-HCG) levels to see if they decrease, indicating a miscarriage
This approach allows for:
– Confirmation of a miscarriage without invasive procedures
– Avoidance of unnecessary interventions
– Monitoring for potential complications