Ectopic Pregnancy: Clinical Review and Diagnostic Strategies

Objective: To review ectopic pregnancy clinically and analyse strategies in the diagnosis of ectopic pregnancy. Methods: Clinical data, symptoms and signs, possible risk factors of 214 documented ectopic pregnancies were retrospectively reviewed in a university based hospital setting. Strategies in the diagnosis of ectopic pregnancy were analysed using ultrasonography, especially transvaginal ultrasonography, serial serum quantitative hCGs with established discriminatory zones, above or below, and using ultrasound only. Results: There was no laterality for tubal pregnancy, but 5 out of 6 cases of cornual pregnancy were on the right side. The most common symptoms and signs of ectopic pregnancy except missed periods were abdominal pain (74.3%) and vaginal bleeding or spotting (59.3%). Seventeen of nineteen cases related patients undergoing assisted reproduction therapy (89.5%) were diagnosed with ectopic pregnacy on a non-emergency basis. Risk factors for ectopic pregnancy were history of ectopic pregnancy, infertility, previous surgery, and presence of intrauterine device. Using ultrasound and discriminatory zone of hCG level 2000 mIU/ml and above, 91(42.5%) cases of the confirmed cases of ectopic pregnacy could be diagnosed correctly. Conclusion: Algorithms combined with ultrasound and hCG are the most commonly used methods for accurately diagnosing ectopic pregnancy. Transvaginal ultrasound and serial quantitative hCGs should be routinely and freely used, especially in atypical ectopic pregnancy.