Atypical Presentation of Ectopic Pregnancy with β-hCG Rise Mimicking a Normal Intrauterine Pregnancy

Abstract

Background: Ectopic pregnancy classically presents with a suboptimal β-hCG rise; however, normal-rise patterns may occur and mislead diagnosis.

Case: A 36-year-old woman presented at 5+2 weeks with rising β-hCG (1,166 → 2,043 mIU/mL; +85%/48h). At 6+4 weeks she developed mild pain and spotting. β-hCG was 19,000 mIU/mL but transvaginal ultrasound revealed an empty uterus and a right adnexal mass.

Laparoscopic salpingectomy confirmed ectopic pregnancy.

Conclusion: A normal β-hCG rise cannot exclude ectopic pregnancy. Ultrasound findings must take precedence over biochemical trends.