Ectopic pregnancy. 'Thinking ectopic,' key to diagnosis
Dorfman, S.F.
Postgraduate Medicine 76(2): 65-68
1984
ISSN/ISBN: 0032-5481 PMID: 6462975 Document Number: 575490
Guidelines for diagnosing ectopic pregnancy are provided. In the US, the number of ectopic pregnancies increased from 17,800 in 1970 to 52,200 in 1980. Physicians must, therefore, be constantyl on the alert for signs for ectopic pregnancy. Diagnostic procedures include taking a detailed history and checking for ectopic pregnancy risk factors. These risk factors include 1) the use of IUDs or progestin-only oral contraceptive (OCs), 2) a history of pelvic infection, and 3) tubal surgery or other abdominal or pelvic surgery. Symptoms of ectopic pregnancy include menstrual irregularity and abdominal pain. However, the absence or presence of these symptoms must be evaluated carefully. Symptoms may not be apparent during the 1st trimester, and cervicities or implantation bleeding may be taken for menses. Findings based on physical manipulation should not be relied upon beacuse it is difficult to differentiate between the physical mainfestions of intrauterine and ectopic pregnancy. Culdocentesis can only diagnos a ruptured ectopic pregnancy, and a ruptured ectopic pregnancy may be missed if blood has not accumulated in the area reached by the exploratory needle. Sensitive urine tests for pregnancy can be used; however, patients with a negative urine test must then be given a pregnancy blood test. If pregnancy tests are positive and evidence of intrauterine pregnancy is not apparent, the clinician must identify the reason for the positive test. Positive pregnancy tests may result from a variety of conditions: ectopic pregnancy, intrauterine pregnancy, incomplete abortion, fetal death in utero, and sequelae of abortion. Serial sonography and serial quantitative tests for beta human chorionic gondadotropin may help the clinician determine which of these conditions is present. Laparoscopy may also be used to diagnosis ectopic pregnancy, but this technique may fail to detect early ectopic pregnancies or pregnancies obscured by adhesions. Ruptured ectopic pregnancy symptoms include hypotension, rapid pulse, and other abdominal signs and symptoms. The appropriate treatment for ectopic pregnancy is laparotomy. If the patient is concerned with preserving her fertility, conservative techniques should be employed, and the surgery should be performed by the most experienced surgeon available.