This Case landed on my desk on November 1st this year. An adventurous
22-year old girl, seeing her Family Doctor.
Serum HCG is 240 U/L.
Clinical information is unusually detailed.
'Termination of pregnancy at end of August.
Unprotected intercourse September 20th, followed by 'morning-after' pill
and a period.
Unprotected intercourse October 26th.
Positive home pregnancy test.
Status?
This Case provoked responses from 46 participants. Two quite correctly
queried my misuse of the English language (I particularly liked 'At 12 she
would be adventurous, at 22 she is simply feckless' - thank you, Tim); and
one remembered my previous similar Case (April 1st 1998) and no, I do not
have her telephone number!
8 would phone to discuss the Case, one stressing that this is an important
result which should not be ignored. [0.0]
10 participants commented 'pregnant'; [0.0]
2 commented 'early pregnancy' [0.8]
5 commented 'very early pregnancy' [1.0]
1 said pregnant 1 - 2 weeks; [-0.3, one assessor commenting 'pregnancy is
counted from LMP, gestation is counted from conception']
1 said pregnant 3 - 4 weeks; [0.5]
5 said pregnant 4 - 5 weeks/ gestation 2 - 3 weeks; [1.0]
2 said 'consistent with 26 October event'; [0.3]
2 said possibly consistent with 20 September event; [0.3]
6 said the result is too high to be related to the October 26 event; [1.0]
6 said pregnant subsequent to the September 20 event. [1.3]
5 said the result could be consistent with incomplete termination of
pregnancy; [0.3]
2 said that this could be residual HCG from the earlier termination; [0.8]
2 mentioned the possibility of choriocarcinoma; [0.3]
2 mentioned the possibility of an ectopic pregnancy; [0.8]
1 said that at this stage of pregnancy, HCG cannot discriminate between
choriocarcinoma and a second conception. [0.5]
12 would suggest a repeat HCG after 2 days; [1.5]
8 would suggest a repeat after 1 week; [1.5]
1 after 2 weeks; [0.0]
1 after 3 weeks; [-0.5]
2 would just suggest a repeat HCG. [1.0]
2 would ask for a urine sample for a pregnancy test; [-1.5]
1 would suggest a progesterone with the repeat HCG. [-1.0]
9 would suggest referral for ultrasound; [-0.5]
1 said at this stage of pregnancy, nothing would be visible by ultrasound.
[0.5]
1 suggested referral to a Gynaecologist; [0.0]
1 suggested referral to a Psychologist. [!]
On my Department's data, this HCG would be average for day 30 pregnancy
(cyesis)/ day 16 gestation.
My comment was
Average for day 30 cyesis, too low for first event and likely to be too
high for second. Could be residual HCG from earlier termination, but
pregnancy arising from second event cannot be excluded. Suggest repeat
after 1 week.
The Summary to Case 76 will be circulated at the end of this week, and
Case 77 will be circulated in the New Millennium.
Best wishes
Gordon Challand
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