The Journal of the Florida Medical Association
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Ectopic pregnancy is an increasingly common and potentially catastrophic condition for which patients often present to the ED with abdominal pain or vaginal bleeding. Recent developments in laboratory tests (sensitive beta hCG, progesterone assays), ultrasonography (transvaginal probes, Doppler ultrasound), and combinations of these modalities (hCG Discriminatory Zone for ultrasonographic evidence of intrauterine pregnancy) have allowed the earlier diagnosis of ectopic pregnancy, with an associated reduction in maternal mortality and morbidity. Understanding the strengths and limitations of the variety of diagnostic modalities available will allow the clinician to formulate a rational strategy for the early diagnosis of ectopic pregnancy. ⋯ Unstable patients require immediate resuscitation and gynecologic consultation; invasive diagnostic methods may supplant laboratory and sonography. Unclear cases may require the use of quantitative beta hCG (discriminatory zone), other pregnancy hormone (progesterone) testing, invasive procedures (laparoscopy, culdocentesis, D & C), or observation (serial beta hCG). A suggested algorithm incorporating these elements is presented (Figure 2).