How to diagnose ectopic pregnancy

We all know that every woman wants to successfully give birth to a healthy baby, but there are always some things that are not satisfactory. Many women are particularly prone to ectopic pregnancy due to physical reasons. However, ectopic pregnancy will have a certain impact on women's physical and mental health. Sometimes, if ectopic pregnancy is not treated in time, it may deprive women of their right to be mothers. Only timely diagnosis of ectopic pregnancy can get more timely treatment. Let's learn about the diagnosis method of ectopic pregnancy.

How to diagnose ectopic pregnancy

1. HCG determination

It is currently an important method for early diagnosis of ectopic pregnancy.

2. Progesterone determination

The serum P level in ectopic pregnancy is low, but it is relatively stable at 5 to 10 weeks of gestation, and a single measurement has a great diagnostic value. Although there is overlap between normal and abnormal pregnancy serum P levels, making it difficult to determine the absolute critical value between them, a serum P level lower than 10 ng/m1 (radioimmunoassay) often indicates abnormal pregnancy, with an accuracy rate of about 90%.

3. Ultrasound diagnosis

Type B ultrasound examination is particularly commonly used for the diagnosis of ectopic pregnancy, and vaginal ultrasound examination is more accurate than abdominal B-type examination.

4. Diagnostic curettage

When ectopic pregnancy cannot be ruled out, a diagnostic curettage can be performed to obtain the endometrium for pathological examination. However, the endometrial changes in ectopic pregnancy are not characteristic and may be manifested as decidual tissue, highly secretory phase with or without A-S reaction, and various secretory and proliferative phases. Changes in the endometrium are related to whether the patient has vaginal bleeding and the duration of vaginal bleeding. Therefore, the diagnosis of ectopic pregnancy based solely on diagnostic curettage has great limitations.

5. Posterior fornix puncture

Posterior uterine fornix puncture is widely used to assist in the diagnosis of ectopic pregnancy. Blood can often be drawn out and does not coagulate after being placed, and contains small blood clots. If no fluid is removed, the diagnosis of ectopic pregnancy cannot be ruled out.

6. Laparoscopy

In most cases, early ectopic pregnancy can be diagnosed after medical history, gynecological examination, blood β-HCG measurement, and B-ultrasound examination. However, for some cases that are more difficult to diagnose, examination under direct laparoscopy can provide a clear diagnosis in a timely manner and surgical treatment can be performed at the same time.

7. Other biochemical markers

It has been reported that the serum AFP level is elevated and the E2 level is low in patients with ectopic pregnancy. The combined measurement of the two with serum HCG and progesterone is superior to single measurement in the detection of ectopic pregnancy. In recent years, the detection of serum CA125 has been combined with β-HCG, and it has been found that the serum CA125 level tends to increase as the β-HCG level decreases. It can be used to identify whether an ectopic pregnancy has resulted in miscarriage or whether the embryo has died.

Differential Diagnosis

1. Threatened abortion in early pregnancy

The abdominal pain of threatened abortion is generally mild, the size of the uterus is basically consistent with the month of pregnancy, the amount of vaginal bleeding is small, and there is no sign of internal bleeding. B-ultrasound can be used for identification.

2. Ovarian corpus luteum rupture and bleeding

Corpus luteum rupture often occurs during the luteal phase, or menstrual period. However, it is sometimes difficult to differentiate from ectopic pregnancy, especially in patients with no obvious history of amenorrhea and irregular vaginal bleeding. β-HCG is often required for diagnosis.

3. Ovarian cyst pedicle torsion

The patient has normal menstruation and no signs of internal bleeding. Generally, there is a history of adnexal mass and obvious tenderness at the cyst pedicle. The diagnosis can be confirmed by gynecological examination combined with B-ultrasound.

4. Rupture and bleeding of ovarian chocolate cyst

The patient has a history of endometriosis, which often occurs before or during menstruation. The pain is quite severe and may be accompanied by obvious anal swelling. The diagnosis can be confirmed by extracting chocolate-like fluid through puncture of the posterior vaginal fornix. If the rupture injures blood vessels, signs of internal bleeding may appear.

5. Acute pelvic inflammatory disease

In acute or subacute inflammation, there is generally no history of amenorrhea, abdominal pain is often accompanied by fever, blood count and erythrocyte sedimentation rate are often elevated, B-ultrasound can detect adnexal masses or pelvic effusion, and urine HCG can assist in diagnosis. Especially after anti-inflammatory treatment, inflammatory manifestations such as abdominal pain and fever can gradually alleviate or disappear.

6. Surgical conditions

Acute appendicitis often presents with obvious migratory right lower abdominal pain, often accompanied by fever, nausea, vomiting, and increased blood count. Ureteral stones cause colic pain on one side of the lower abdomen, accompanied by ipsilateral flank pain and hematuria. The diagnosis can be confirmed by combining ultrasound and X-ray examination.

treat

Salpingectomy is suitable for emergency patients with internal bleeding and shock who have no desire to have children. Young women who wish to have children can undergo fallopian tube fenestration.

The above is an introduction to the diagnosis methods of ectopic pregnancy. After understanding it, we know that although the treatment of ectopic pregnancy is relatively important, some of its symptoms are sometimes abdominal pain, which often have certain similarities with some other diseases. Therefore, when similar symptoms appear, we must go to a specialized hospital for diagnosis and then treatment.