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Diagnosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The gravity of this condition warrants early diagnosis. With modern methods, diagnosis may be made within 6 weeks of amenorrhoea, and frequently whilst the mother has no symptoms. An awareness of risk factors helps to identify patients in whom early investigations may be warranted.

The result of a pregnancy test (urine beta HCG) is essential to help determine further management.

A transvaginal ultrasound is the preferred method of investigation (1).

  • sensitivity of diagnosing ectopic pregnancies varies from 73 to 93%
  • it may reveal viable or nonviable intrauterine pregnancies, ectopic pregnancies or no visible pregnancies (a pregnancy of unknown location)
  • can identify intrauterine pregnancies longer than 5.5 weeks with almost 100% accuracy (2)

Laparoscopy allows direct visualisation of an ectopic pregnancy but may fail if the pregnancy is early and the gestational sac small. It is of little value in a ruptured ectopic pregnancy when the peritoneum is blood filled.

Aspiration through the posterior vaginal fornix into the pouch of Douglas may be of help in a ruptured ectopic pregnancy when free blood is present.

If the diagnosis is in doubt then serial serum beta hCG measurements are taken to distinguish between a potentially viable intrauterine gestation, a resolving spontaneous abortion, and an ectopic pregnancy (2).

  • in normal pregnancies, this will double about every two days (1) - a 66% rise in beta-hCG every 48-hours can be seen in 85% of viable intrauterine pregnancies during the first 40 days of gestation (3)
  • in abnormal pregnancies, intrauterine or ectopic, there is impaired beta hCG production and a prolonged doubling time (1) - a 66% rise in beta-hCG every 48-hours can be seen in 13% of ectopic pregnancies during the first 40 days of gestation (3)
  • if the rise is less than 50% in 48 hours, it is almost always associated with a nonviable pregnancy (either intrauterine or extrauterine) (3)

A Group and Save sample is taken. This allows the maternal blood group to be ascertained (and hence the possibile requirement for anti-D) and allows blood to be cross-matched in cases of haemodynamic compromise.

Reference:


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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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