Ectopic Pregnancy: Diagnosis
H&P, serial hCG levels, decreased progesterone levels, decreasing estradiol levels, increasing MSAFP, C-reactive protein and CA-125 levels, vaginal US, cureyyage, culdocentesis (+if ruptured but <20% will not be +), laparoscopy (misses 2-4% due to being small plus risk and expense is increased).
If hCG fails to increase by at least 66% or > in 2 days –> a non-viable pregnancy should be assumed. hCG<50% increase in 48 h --> abnormal pregnancy.
Abnormal pregnancy then hCG rises or falls very slowly and NO POC or pathology –> strongly suspect ectopic.
Serum progesterone
- <5ng/ml -->abnormal pregnancy
- >25ng/ml –> lviable pregnancy
- <15ng/ml --> most ectopics
Ultrasound diagnosis – sca can normally be seen with TVUS when hCG level is between 1000 and 2000 mlU/ml (first and second IRP).
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