When I see pregnant women in the clinic, I often encounter pregnant women who have just come to the hospital for checkups. The first thing they say when they enter is: “Doctor, I am pregnant, I came to the hospital to confirm.” In the past, it did not matter in the public hospital, the patient was given a list to go to the urine test, the registration fee and urine test is not much money, but now working in a private hospital, several hundred dollars of consultation fees plus laboratory fees, I really feel for the patient this money. But the bottom line is that at this stage when you just found out you are pregnant – there is nothing the doctor can do. If you want to confirm your pregnancy, it is enough to take a pregnancy test at home, the hospital takes the same test strips to confirm pregnancy, not much high-tech. Two lines indicate that you are pregnant, one line is not pregnant, one dark and one light indicates a weak positive test, which is probably a new pregnancy. The difference is that the hospital will issue a report based on the results. Once pregnancy is confirmed, the next step is to clarify whether the pregnancy is intrauterine or ectopic. If it is an intrauterine pregnancy, is the embryo developing well. This is the time to use ultrasound. However, it is important to know that for a woman with a normal menstrual cycle of about 28 days, an ultrasound is usually done around 40 days after menopause (from the first day of the last menstrual period) to determine whether the pregnancy is intrauterine or ectopic, which means that the period is delayed by about 10 days. An ultrasound performed too early may not reveal anything or may only reveal an echogenic area before the yolk sac, which is the marker of an intrauterine or ectopic pregnancy. In addition the germ and primitive heart tube pulsations, which are signs of a well developed early embryo, are usually not visible until after 6 weeks of menopause. Some patients may say, “I am coming for an abortion, isn’t it better to have an abortion as early as possible? Not really! How do you know if you will have an ectopic pregnancy when your menopause is 31 or 32 days old and the embryo hasn’t even grown? You can’t blindly have an abortion or a medication abortion without knowing for sure whether it is an intrauterine pregnancy or an ectopic pregnancy. There will also be patients who say, “I am trying to rule out an ectopic pregnancy. The pathological basis of ectopic pregnancy is that the fertilized egg lays outside the uterus. 99% of ectopic pregnancies are tubal pregnancies, in which the fertilized egg lays on the fallopian tube with a very thin muscular layer, and it is very easy for the embryo to break the tube as it grows, causing intra-abdominal hemorrhage. However, the fallopian tubes are long and thin, and are affected by the surrounding intestinal gas and fecal masses, so ultrasound is often more advanced than in the case of intrauterine pregnancy, which means that the real danger usually occurs more than 40 days after menopause. Therefore, there is no point in coming to the hospital for an ultrasound to rule out an ectopic pregnancy as soon as the pregnancy is detected. There is another type of patient who comes to the hospital early after a pregnancy test has confirmed her pregnancy because she wants to have a blood test for progesterone. There is no doubt that progesterone is important for maintaining a stable fertility status, but we do not recommend progesterone as a routine monitoring indicator during pregnancy. This is because serum progesterone levels vary greatly among individuals, and even progesterone checked at different times in the same person can be different, which is related to peak progesterone pulses, function of progesterone receptors, etc. For more details, please refer to the previous tweet “Should progesterone be routinely checked during early pregnancy or not? In fact, a low progesterone level is not a judgment of pregnancy outcome. On the contrary, we often encounter many pregnant women with persistently low progesterone levels who continue their pregnancy without signs of miscarriage. Progesterone is usually recommended only in clinical cases with conclusive evidence of luteal insufficiency and in vitro fertilization. Therefore, the monitoring of progesterone varies greatly among individuals and is less of a practical clinical reference than blood HCG, and monitoring progesterone is not as important as monitoring the rising levels of HCG, called human chorionic gonadotropin, which increases at a rate of 66% per day in early pregnancy, i.e., HCG values double at normal intervals of 48 hours, reaching a peak after 8 weeks of pregnancy and then slowly decreasing until the fourth trimester, until maintained until until the end of the pregnancy. If the doubling of HCG is good, then there is a high probability of intrauterine pregnancy and good embryonic development, while if the rise of HCG is not good or even continues to be low, then there is a high probability of ectopic pregnancy or poor embryonic development. Of course, if you have the following conditions, it is better to go to the hospital as soon as possible after pregnancy to check and see if you need to apply medicine according to the situation: 1. vaginal bleeding; 2. history of recurrent miscarriage (more than two spontaneous abortions); 3. history of ectopic pregnancy; 4. hidden pain, cramping pain, anal swelling feeling in one side of the lower abdomen, or even sudden and severe pain in one side of the lower abdomen spreading to full abdominal pain (suspected ectopic pregnancy); 5. patients with polycystic ovary syndrome patients with ovulation disorders such as polycystic ovary syndrome; 6. after IVF conception. So if you are all right, when you do not have a period to run to the hospital is too much of a hurry, urine test – spend money, do ultrasound – too early, most doctors, including me, have to take the strategy of not letting patients come in vain, test blood HCG and progesterone. Otherwise nothing is done to drive the patient home patients often psychologically unacceptable. But in fact, checking progesterone is not a routine part of pregnancy testing, and checking blood HCG once is useless and must be monitored again 48 hours apart to be clinically meaningful. So regardless of your choice of where to keep your baby, if you conceive naturally, have no history of abnormal diseases, no vaginal bleeding or other discomfort, the best time to go to the hospital for ultrasound after 6 weeks of menopause is the best time to save time, money and effort.