Ectopic pregnancy: uncommon presentations and difficulty in diagnosis

Diagnosis of ectopic pregnancy prior to rupture is an arduous task even with the availability of many new investigative methods and imaging modalities. Above all, a high index of suspicion is necessary when dealing with women who present in early pregnancy with abdominal pain and vaginal bleeding. With the increased use of ovulation induction agents, the probability of heterotropic pregnancy should be kept in mind. The use of transvaginal ultrasonography (TVS) will help in earlier diagnosis because of its advantages over transabdominal ultrasonography (TAS).