No, This is NOT an Ectopic Pregnancy
With a β-hCG of 2300 mIU/mL and transvaginal ultrasound demonstrating a gestational sac, yolk sac, and fetal pole, this is definitively an intrauterine pregnancy, not an ectopic pregnancy. 1
Why This Confirms Intrauterine Pregnancy
The presence of a yolk sac within an intrauterine fluid collection is incontrovertible evidence of a definite intrauterine pregnancy. 1 This finding alone essentially excludes ectopic pregnancy in spontaneous (non-assisted) conceptions with near complete certainty. 1
The visualization of a fetal pole further confirms this is a viable intrauterine pregnancy at the appropriate developmental stage. 1
At β-hCG 2300 mIU/mL, you are well within the range where these structures should be visible on transvaginal ultrasound (discriminatory threshold is approximately 3,000 mIU/mL). 1
Understanding the β-hCG Discriminatory Threshold
The discriminatory threshold (approximately 3,000 mIU/mL) refers to the β-hCG level at which a gestational sac should be visible if an intrauterine pregnancy exists. 1, 2
When NO intrauterine pregnancy is seen at β-hCG ≥3,000 mIU/mL, ectopic pregnancy becomes highly likely. 1, 2 This is the opposite of your scenario.
In your case, the β-hCG is 2300 mIU/mL AND you have clear intrauterine structures visible—this is a normal finding. 1
Expected Ultrasound Findings at Different β-hCG Levels
- Gestational sac becomes visible around 1,000-2,000 mIU/mL 1, 3
- Yolk sac typically appears when β-hCG reaches approximately 7,200 mIU/mL, though it can be seen earlier (as in your case) 3
- Embryo with cardiac activity is expected when β-hCG exceeds 10,800 mIU/mL 3
Next Steps in Management
Proceed with routine prenatal care. 1 This patient has a confirmed viable intrauterine pregnancy.
Schedule follow-up ultrasound at 7-8 weeks gestational age to document cardiac activity, as the fetal pole should demonstrate heartbeat by that time. 1
Counsel the patient about normal first-trimester symptoms including nausea and vomiting, which typically begin at 4-6 weeks and peak at 8-12 weeks. 1
Critical Pitfall to Avoid
- Do not confuse the discriminatory threshold concept. 1, 2 The threshold is used when ultrasound shows NO intrauterine pregnancy—it helps identify when ectopic pregnancy should be suspected. When you actually SEE intrauterine structures (especially a yolk sac), the β-hCG level becomes irrelevant for diagnosing location. 1