How to determine ectopic pregnancy?

Once women become pregnant, they need to go to the hospital for check-up in time to find out whether it is a normal pregnancy. Especially if abdominal pain symptoms occur in the early stages of pregnancy, they must go for a check-up in time, such as an ultrasound examination, a laparoscopy, and a progesterone level test, etc. These scientific methods can determine whether an ectopic pregnancy has occurred.

How to determine ectopic pregnancy?

When ectopic pregnancy does not result in miscarriage or rupture, the clinical manifestations are not obvious, diagnosis is difficult, and auxiliary examinations are required for a confirmed diagnosis.

After miscarriage or rupture of ectopic pregnancy, diagnosis is usually not difficult. If there are difficulties, the changes in the condition should be closely observed. If there is continuous vaginal bleeding, aggravated abdominal pain, increased pelvic mass and a downward trend in hemoglobin, these will help to confirm the diagnosis. The following tests can also be used to assist in diagnosis:

1. hCG determination: Urine or blood hCG is crucial for the early diagnosis of ectopic pregnancy. In ectopic pregnancy, the hCG level in the patient's body is lower than that in intrauterine pregnancy. Continuously measure blood hCG. If the doubling time is greater than 7 days, the possibility of ectopic pregnancy is high; if the doubling time is less than 1.4 days, the possibility of ectopic pregnancy is extremely small.

2. Progesterone determination: The determination of serum progesterone is helpful in judging the development of the embryo in a normal pregnancy. In ectopic pregnancy, serum progesterone levels are low, mostly between 10-25ng/ml. If the serum progesterone value is >25ng/ml, the probability of ectopic pregnancy is less than 1.5%; if its value is <5ng/ml, intrauterine pregnancy abortion or ectopic pregnancy should be considered.

3. Ultrasound diagnosis: If no gestational sac is detected in the uterine cavity, but an abnormal low-echo area is detected beside the uterus, and the embryo and primitive heart tube pulsation are seen, ectopic pregnancy can be confirmed. If there is a mixed echo area and a free dark area in the uterine rectal fossa during parauterine exploration, even if no embryo or fetal heartbeat is seen, ectopic pregnancy should be highly suspected.

Combining blood hCG measurement with ultrasound examination is very helpful in the diagnosis of ectopic pregnancy. When blood hCG>2000IU/L and no intrauterine gestational sac is seen by vaginal ultrasound, the diagnosis of ectopic pregnancy is basically established.

4. Laparoscopic examination: Laparoscopic examination is the gold standard for the diagnosis of ectopic pregnancy, and laparoscopic surgical treatment can be performed at the same time as the diagnosis is confirmed. However, about 3%-4% of patients are missed due to the small gestational sac. They may also be misdiagnosed as a pregnancy due to the dilation and color change of the fallopian tube. This should be paid attention to.

5. Posterior vaginal fornix puncture: suitable for patients suspected of intra-abdominal bleeding. Intra-abdominal bleeding is most likely to accumulate in the rectouterine pouch. Even if the amount of bleeding is not large, blood can be drawn out through puncture of the posterior vaginal fornix. In the case of old ectopic pregnancy, small pieces of old blood or non-coagulated blood may be drawn out. When there is no internal bleeding, the amount of internal bleeding is very small, the hematoma is located higher, or there is adhesion in the rectouterine pouch, blood may not be able to be drawn out. Therefore, a negative posterior vaginal fornix puncture cannot rule out tubal pregnancy.

It should be noted that ectopic pregnancy cannot be detected using early pregnancy test strips. Early pregnancy test strips determine whether pregnancy occurs by detecting the hCG content in the human body, but they cannot determine the location and implantation status of the fertilized egg. When a woman has an ectopic pregnancy, the early pregnancy test will be positive. It is recommended that women conduct B-ultrasound and blood hCG to further confirm the pregnancy as soon as possible after discovering that they are pregnant.