Positive Pregnancy Test After Hysterectomy: Causes and Evaluation
A positive hCG test after hysterectomy (uterus removed) is unexpected. Possible explanations:
- Residual trophoblastic tissue: From recent pregnancy (miscarriage, termination, delivery) — hCG declines slowly (half-life 24–36 hrs); can persist weeks.
- Ovarian pregnancy (ectopic): Rare; ovary retains follicular tissue. hCG positive; US shows adnexal mass.
- Gestational trophoblastic neoplasia (GTN): Persistent molar tissue, choriocarcinoma — hCG rises/plateaus.
- hCG-secreting tumors: Ovarian germ cell, lung, gastric, renal.
- Pituitary hCG: Perimenopausal; low, stable levels (<5–10 mIU/mL); LH/FSH high.
- Exogenous hCG: Fertility treatment (trigger shot) — persists 7–14 days.
- Assay interference: Heterophile antibodies, rheumatoid factor.
Evaluation: Quantitative serum β-hCG (serial), pelvic/transvaginal US, review meds/history. Refer to gyn-onc if GTN suspected.
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