Quantitative Serum bhCG and Discriminatory Zone

When no IUP is noted and no sonographic "ancillary findings" of EP exist, a quantitative serum bhCG should be obtained if not already done. In using quantitative serum bhCG in a protocol to rule out ectopic pregnancy, the concept of discriminatory zone is important. A discriminatory zone is the serum bhCG level above which an intrauterine pregnancy is expected to be visualized sonographically. A discriminatory zone serum bhCG level of 2000 mIU/mL is commonly used. 23 and 4 A pregnancy with a serum bhCG level above 2000 mIU/mL without sonographic evidence of an IUP should be considered an ectopic pregnancy until proven otherwise and an ob/gyn consult should be obtained. With a low serum bhCG (<2000) and no IUP or "ancillary findings," most gynecologists recommend a conservative approach with repeat serum bhCG titers and ultrasound studies in 3 to 7 days.3 The discriminatory zone serum bhCG level may be adjusted depending on institutional variation and preference.

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