If hcg is far below the discriminatory zone, how can ectopic be diagnosed in the absence of pain? does decreasing hcg imply that ectopic is resolving?

Ectopic: A falling hcg typically signals a resolving pregnancy. Ultrasound can be an excellent way to diagnose ectopic pregnancy. Women that have had ectopic gestational often know before any testing can reveal the problem.

Tracking BHCG: A dropping BHCG could be a resolving ectopic or a resolving miscarriage. Often it is challenging to know the difference. A sonogram can still be a useful tool even at low BHCG numbers. An experienced Obgyn will be able to guide you through this. Follow up is key.

Often but not always: In very early pregnancy, when betaHCG levels are very low, only in the hundreds ("far below the discriminatory zone"), it seems practically impossible to "diagnose an ectopic" using current technology. Some ectopic are reported to "resolve spontaneously", and "decreasing HCG" usually implies that the ectopic is resolving . Unfortunately, intraabdominal bleeding may still occur in rare cases.