[Ectopic pregnancy: contribution of paraclinical investigations, ultrasonography excluded]

Because a misdiagnosis of ectopic pregnancy (EP) exposes patients to a vital risk, paraclinical exams have to be highly specific and as sensitive as possible. As the accuracy of diagnostic tools depends on the prevalence of the disease in different patient groups, clinical signs have to be considered when analyzing the literature (symptom-free women, complaints, risk factors...). In the first part of this review, various diagnostic tools are reviewed and the particular features of EP after assisted reproduction techniques are taken into account. The evaluation of serum quantitative betahCG level is primordial. In difficult cases when transvaginal ultrasound does not detect an intrauterine gestational sac, repeated betahCG measurements and determination of serum progesterone levels allow to evaluate the viability of an early pregnancy. If ultrasound diagnosis cannot be obtained without significant delay, culdocentesis is easy to perform and has a good positive predictive value. However, the detection of intrauterine chorionic villi is only of limited diagnostic value, whereas hysteroscopy may be of interest in some cases. In the second part an analysis of algorithms in the diagnostic management of EP is carried out. Currently, a standard protocol should not be applied for all patients and specific algorithms have to be defined according to the prevalence of EP in the treated population.