Detection Of Ectopic Pregnancy Research Articles

Choriogonadotropin in urine or serum for detection of ectopic pregnancy?

Choriogonadotropin in urine or serum for detection of ectopic pregnancy?

Detection of ectopic pregnancy in an outpatient population: The role of the beta-HCG level

A retrospective analysis was made of 265 female outpatients who initially presented to an emergency department with a complaint of amenorrhea, vaginal bleeding, or abdominal/pelvic pain. The patients were discharged from the emergency department pending results of a serum pregnancy test. Forty-five of the patients were subsequently found to have an elevated (>5 mIU/mL) beta human chorionic gonadotropin (HCG) level. Six of the patients had an ectopic pregnancy; their beta HCG levels ranged from 19 to 265 mIU/mL. A detectable beta HCG level less than 500 mIU/mL had a 33076 probability of an ectopic pregnancy in the study group. Historical features, physical examination, and laboratory parameters were of limited value for identification of minimally symptomatic outpatients at risk for an ectopic pregnancy. No study patient had a systolic blood pressure of less than 86 mm Hg on presentation. A comparison group of 29 patients admitted to the hospital directly from the emergency department with a diagnosis of “rule out ectopic pregnancy” during the same time interval was identified. Nine of the directly admitted patients were found to have ectopic pregnancies. A statistically greater proportion of the directly admitted patients had a hematocrit less than 35% and a positive urine (tube) pregnancy test than that found for the study group. Five of the comparison group patients were noted to have a systolic blood pressure of less than or equal to 80 mm Hg. The beta HCG was found to be an essential tool in the evaluation of potential ectopic pregnancy in patients with minimal symptomatology.

Diagnosis of Ectopic Pregnancy

ABSTRACT To the Editor.— The outline for the detection of ectopic pregnancy by Dr Morton Stenchever (1982;247:1190) was thorough. I especially agree with his mandate to attempt limitation of the surgery and anesthesia attendant to laparoscopy. Culdocentesis is a rewarding procedure, but the results are only positive with ectopic rupture or leakage.That is why the use of ultrasonography, a noninvasive technique, in the differential diagnosis of ectopic pregnancy should be emphasized strongly. The finding of an intact intrauterine gestational sac is possible by four weeks and yields the diagnosis in all but the unlikely instance of a combined pregnancy. In more advanced ectopic pregnancies, fetal cardiac pulsations in an adnexal mass will verify the diagnosis.

The Early Diagnosis of Ectopic Pregnancy

In a survey of 235 consecutive cases of ectopic pregnancy it was found that over 50 per cent were incorrectly diagnosed by the general practitioner and 36 per cent by a hospital doctor. Ten per cent of patients were sent home before the diagnosis was made. Over 30 per cent of patients were sent to general surgical wards and these patients had different characteristics from those sent to gynaecological wards. High risk patients can be identified from their past history. The increasing use of the laparoscope has been associated with earlier detection of ectopic pregnancy before the stage of rupture.