<prompt> A female has history of 6 weeks amenorrhoea, USG shows no sac, serum beta HCG-1000 IUL. What would be the next step in management of the patient?Medical managementRepeat HCG after 48 hoursRepeat HCG after 1 weeksNone of the above  <response>: In normal intrauterine pregnancy the level HCG doubles every 48 hours whereas in ectopic pregnancy the level of HCG shows a slow rise or it plateaus. Since the USG in this patient does not show a sac and the level of HCG is low its level should be repeated after 48 hours to exclude ectopic pregnancy. In normal pregnancy at 5-6 weeks of gestation, a gestational sac is visible on ultrasound. A beta-hCG level of 6500 mUmL with an empty uterine cavity by transabdominal ultrasound is highly suspicious for an ectopic pregnancy. A beta-hCG value of 2000 mUmL or more can be indicative of an ectopic pregnancy if no products of conception are detected within the uterine cavity by transvaginal ultrasound. Ref: Rogers V.L., Worley K.C. 2013. Chapter 19. Obstetrics Obstetric Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow Eds, CURRENT Medical Diagnosis Treatment 2014. 