Problems and benefits in early diagnosis of ectopic pregnancy

A 5-yr retrospective study is presented of 168 consecutive patients operated on for ectopic pregnancy during 1977-1981, showing the prevalent features and trends of this disorder and its diagnosis. The overall incidence was 1.48% of deliveries, with a range of 1.00-2.34%. The number of unruptured cases (52.1%) in the series reflects the low gestational age. Some of the problems (and benefits) commonly associated with early diagnosis are surveyed. The presenting symptoms at arrival are compared between patients with an IUD in situ (33.3%) and those without, and between patients with a delay in diagnosis (47.6%) and those without. The use and the results of the diagnostic procedures are also compared between the latter two groups. An absence of clear amenorrhoea was significantly more common (P less than 0.005) in IUD-users than in non-users. Spotting was almost significantly more common (P less than 0.025) among patients with a delayed diagnosis than in those who underwent an operation on the first day seen. It is shown that patients whose diagnosis was delayed had had significantly more often either curettage (P less than 0.001) or an ultrasound examination which (in spite of a positive pregnancy test) did not show an intrauterine pregnancy (P less than 0.005) than those whose diagnosis was not delayed. It is emphasized that the physician should be on the alert in excluding the possibility of ectopic pregnancy in IUD patients and suspected spontaneous and threatened abortions, especially. In such cases an active laparoscopy is again recommended.