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A case of PUL (Pregnancy of unknown location- pregnancy test positive with…

- - - - IUP
      - Ectopic
      - PUL
        
        Repeat the BhCG two more times after you appreciated a PUL above the DZ - and repeat the TVUS with BhCG
        
        BhCG pattern
        
        Decreasing titre
        
        Dying (miscarriage or dying ectopic)
        
        No further TTT - just keep repeating weekly the BhCG till negative (to avoid undiagnosed GTN)
        
        Doubling
        
        Laparoscopy - Methotrexate will be less effective in this BhCG range
        
        Plateau or slowly rising - less than doubling
        
        TVUS showed an ectopic or IUP
        
        still PUL
  - - - Decreasing titre
        
        Dying (miscarriage or dying ectopic)
        
        No further TTT - just keep repeating weekly the BhCG till negative (to avoid undiagnosed GTN)
      - Doubling
        
        Keep repeating BhCG and TVUS till it reaches the DZ - this finding suggests IUP but does NOT exclude ectopic pregnancy
        
        Keep repeating TVUS until you can see an IUP or ectopic or until you hit the DZ
      - Plateau or slowly rising - less than doubling
        
        Repeat BhCG two more times after you appreciated a plateau or a slowly rising titre - and repeat TVUS with BhCG
        
        TVUS confirmed IUP
        
        TVUS confirmed ectopic
        
        Still PUL
        
        Laparoscopy (better) - OR Administration of Methotrexate with D and C