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Obstetrics & Gynecology

Answer 1
  1. hCG. Any woman of reproductive age presenting with pain and irregularity of the menstrual cycle should be tested for pregnancy. Qualitative urine tests for hCG are as sensitive for detecting early pregnancy as serum tests. If the test is negative, the differential diagnosis would include PID and abnormalities of the genital tract (eg, ovarian cysts, fibroids), urinary tract (eg, kidney/ureteral stones), or gastrointestinal tract (eg, diverticulitis, appendicitis). Diagnostic tests, such as complete blood counts, radiography, ultrasonography, and CT scans, may then become useful. If the test is positive, the location of the pregnancy must be established to rule out ectopic pregnancy. TVUS would therefore be the next most useful test after pregnancy is established. Serum progesterone levels would be useful to distinguish viable from nonviable pregnancies, although this will not indicate the location of the pregnancy. High progesterone levels (> 20 ng/mL) are usually associated with fetal viability, whereas low levels (< 5 ng/mL) are usually associated with nonviable pregnancies.1

    1. Herbst AL, Mishell DR, Stenchever MA, Droegemueller W. Ectopic pregnancy. In: Comprehensive gynecology. 2nd ed. St. Louis: Mosby-Year Book; 1992:457-88.

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