What Is Involved in Making a Diagnosis of Ectopic Pregnancy?

In an ectopic pregnancy, a fertilized egg implants in an area outside the uterus. This condition occurs in approximately one out of every 50 pregnancies and is usually discovered between the fifth and eighth week of gestation. Diagnosis of ectopic pregnancy first requires a presentation of symptoms accompanied with a positive urine pregnancy test. Physical examination, blood tests, ultrasound imaging, and occasionally, exploratory surgery may be needed to confirm the diagnosis.

The early symptoms of ectopic pregnancy are identical to those of normal pregnancy. Often, a missed period is the first indication, but other symptoms such as tender breasts, nausea, and increased urination are also common. As gestation advances, however, a woman who has an ectopic pregnancy often begins to experience mild to moderate pelvic pain and spotting. In many instances, these symptoms can be mistaken for the beginning of a menstrual period.

Unlike normal menstruation, the pelvic tenderness of an ectopic pregnancy continues to become more severe, as will vaginal bleeding. In rare instances, the development of an embryo inside a fallopian tube can cause the tube to rupture. This is accompanied with severe pain and very heavy bleeding. The resulting internal bleeding can lead to dizziness, rapid heartbeat, and weakness. Although diagnosis of ectopic pregnancy regularly happens before the fallopian tube ruptures, death is likely if this condition goes untreated.

As ectopic pregnancies produce the same hormones as regular pregnancies, the first step in the diagnosis of ectopic pregnancy is generally a urine pregnancy test. If pain or bleeding accompany a positive pregnancy test, additional blood tests and an ultrasound of the patient’s uterus are usually ordered. A physical exam to check uterine growth and cervical closure is frequently necessary as well.

A confirmed diagnosis of ectopic pregnancy requires visual confirmation through ultrasound or, more rarely, exploratory laparoscopic surgery. A preliminary confirmation of the condition, however, can be made if blood tests show a significant rise in the pregnancy hormone human chorionic gonadotropin (HCG) and there is no evidence of a uterine pregnancy. As these conditions can also point to a very early pregnancy, a physician may choose to continue monitoring HCG levels to confirm diagnosis in patients who are not in immediate danger.

Unfortunately, embryos that have implanted outside the womb cannot be saved; termination inevitably follows a diagnosis of ectopic pregnancy. If the condition is detected early enough, the patient is injected with a medication to induce miscarriage. In cases where fallopian tube rupture is likely, immediate surgery is usually required.