TUBAL ECTOPIC PREGNANCY: DIAGNOSIS AND INVESTIGATIONS

CONTENT

-INTRODUCTION

-DIFFERENTIAL DIAGNOSES

-INVESTIGATIONS

 

INTRODUCTION

The management of ectopic pregnancy typically depends on the presentation of the disease, see TUBAL ECTOPIC PREGNANCY: AN OVERVIEW OF THE CAUSES, RISK FACTORS, PRESENTATION AND COMPLICATIONS. Typically varying at presentation from a seemingly symptomless and harmless condition to an acute life threatening emergency, your doctor may perform the routine action of taking a history, performing a physical examination and running some investigations, if you present without any major symptoms other than merely missing your menses with or without some vaginal bleeding or he/she may perform immediate resuscitative measures along with some emergency surgical procedures if you present with symptoms suggestive of severe shock, such as some episodes of fainting attacks or if you were unconscious. Below are examples of other diseases that may present with symptoms similar to ectopic pregnancy. 

 

DIFFERENTIAL DIAGNOSES

1.  Appendicitis

2.  Miscarriage

3.  Ovarian Cysts

4.  Diverticulitis

5.  Pelvic Inflammatory Disease

6.  Torsioned Uterine fibroids

7.  Urinary tract infections

While these are just a few of the many diseases that may present similar to an ectopic pregnancy, it is very important that you consult a specialist as soon as you miss your period in order to confirm the presence of a pregnancy as well as its location, by so doing effectively exclude any chance of ectopic pregnancy which remains a potential cause of death in all women of reproductive age group worldwide.

 

INVESTIGATIONS

1.  Serum Pregnancy test; this is to confirm if you are pregnant or not. The blood or serum pregnancy test is more sensitive and accurate and clinically favored over the use of urine pregnancy test. If negative then you do not have an ectopic pregnancy

2.  Ultrasound scan; this is to localize the site of pregnancy (i.e. within or outside the uterus), its viability and help determine the modality of treatment. Transvaginal scan is the preferred choice of ultrasonography in this case.

3.  Serum Beta HCG (β HCG) assay; this is a quantitative or actual measurement of the pregnancy hormone secreted by the placenta of the ectopic pregnancy, the same hormone used in testing for the presence or absence of pregnancy. It is used in conjunction with ultrasound scan to aid in the diagnosis of ectopic pregnancy, determine the modality of treatment, prognosticate the treatment outcome and to monitor the resolution of the ectopic pregnancy for those on medical or conservative management of ectopic pregnancy.

4.  Serum progesterone test; its use is similar to the above and can be used in conjunction with the serum β HCG assay and ultrasound scan.

5.  Paracentesis; this refers to the aspiration of blood from the abdominal cavity in patient suspected of significant intra-abdominal bleeding following a case of suspected ruptured ectopic pregnancy. This is often done in emergency situation where facilities for above investigations are not readily available and there exists a strong clinical suspicion of ruptured ectopic pregnancy. This however is not routinely performed by most specialists as presence or absence of blood on aspiration does not necessarily confirm or refute ruptured ectopic pregnancy.

6.  Culdocentesis; this is similar to the above investigation and involves the aspiration of blood from the POD via the vagina.

7.  Diagnostic Laparoscopy; Due to the various diseases that may present similarly to ectopic pregnancy and the resulting dilemma associated occasionally with the diagnosis of ectopic pregnancy, the confirmatory investigation done to confirm ectopic pregnancy when the other investigations are inconclusive is the diagnostic laparoscopy. This involves the use of an endoscopic tube to visualize the abdominal cavity and the fallopian tubes under direct vision in order to make a diagnosis of ectopic pregnancy via a pin hole surgical technique under anesthesia.

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REFFERENCES

1.  American Pregnancy Society: americanpregnancy.org/pregnancy-complications/ectopic pregnancy.

2.  MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2006 Feb 21]. Pregnancy Loss; [updated 2006 Feb 22; reviewed 2006 Feb 7; cited 2006 Feb 22]. Available from: http://www.nlm.nih.gov/medlineplus/pregnancyloss.html

3.  Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 10. MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2006 Feb 21]. Ectopic Pregnancy; [updated 2010 Feb 21;] Available from http://www.nlm.nih.gov/medlineplus/ency/article/000895.htm