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).
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).
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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