Problems in the diagnosis of ectopic pregnancy

Problems in the diagnosis of ectopic pregnancy have been assessed over a 4-month period at King Edward Memorial Hospital. Twenty-three of thirty women (77%) were sent home after their initial presentation with symptoms of their ectopic pregnancy. Thirteen were sent home from major teaching hospitals and the remaining 10 by their general practitioners. In 76 patients, laparoscopy was performed to exclude ectopic pregnancy; the diagnosis was confirmed in only 30. Plasma beta HCG values were elevated in all patients with an ectopic pregnancy within the Fallopian tube. The finding of a beta HCG value of less than 2.5 i.u./l could have allowed 36 of these patients to avoid diagnostic laparoscopy. Nine patients with intrauterine pregnancies (5 continuing and 4 aborting) might have avoided laparoscopy if ultrasonography had been used. Careful application of these tests, together with good history taking, will minimise the number of patients in whom an incorrect diagnosis is made.