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Today, an ectopic pregnancy can be diagnosed very early using blood tests for HCG and vaginal ultrasound. Both these tests need to be done simultaneously in order to interpret them correctly. The beta HCG is a very specific "marker" for pregnancy. This blood test is very sensitive and, if negative, virtually excludes the possibility of an ectopic pregnancy. A positive HCG level confirms that the patient is pregnant, but does not provide information about the site of the pregnancy.
A vaginal ultrasound allows the doctor to locate the gestational sac of the early pregnancy. Occasionally, the sac may be seen outside the uterus, making a positive diagnosis of ectopic pregnancy on sonography. Often, however, the sac cannot be seen clearly in ectopic pregnancies, especially if it is at an early stage. Then, both the scan and HCG levels need to be studied. In a normal intrauterine pregnancy, the doctor should be able to see a gestational sac in the uterine cavity on vaginal ultrasound, if the HCG level is more than 2000 mIU/ml (this is called the discriminatory zone). However, if the level is more than 2000 mIU/ml and the doctor cannot see a gestational sac, this means that the diagnosis is an ectopic pregnancy.
Another blood test which can be helpful is the determination of the serum progesterone level, which is lower (less than 15 ng/ml) in patients with ectopic pregnancies, as compared to normal pregnancies.
Sometimes, differentiating between an ectopic pregnancy and an early miscarriage can be difficult. In these cases, if curettage shows that there is no pregnancy tissue in the uterus (as tested by histopathologic examination), then an ectopic is suspected. The diagnosis can be confirmed by laparoscopy, if needed, which shows that the pregnancy is in the tubes, where it appears as a dark bluish bulge.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
