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Ectopic Pregnancy

How Is Ectopic Pregnancy Diagnosed?

Last modified: 
22/03/2012 - 11:18

Contributing Author: Guy Slowik FRCS

If you show up at a doctor's office with irregular or missed periods, or at an emergency room with pelvic pain, the first test a doctor will perform is a urine test for pregnancy.

  • A negative pregnancy test will exclude ectopic pregnancy.
  • A positive pregnancy test will establish the presence of a pregnancy but not its location.

If the doctor suspects that your pregnancy may be ectopic or otherwise abnormal, further testing may be necessary. These tests may include:

Quantitative hCG Test

If you already know that you are pregnant, or if the urine test the doctor performed came back positive, the next step is usually a blood test called a quantitative hCG test. This measures levels of a hormone called human chorionic gonadotropin (hCG). This hormone is produced by the placenta, an organ that develops as pregnancy progresses to nourish and protect the developing baby.

hCG shows up in blood and urine tests as early as ten days after fertilization occurs. hCG levels double every two days for the first ten weeks of pregnancy. If your doctor suspects that you might have an ectopic pregnancy or another pregnancy problem, he or she might test your hCG level every few days. If your hCG levels are lower than they should be for your stage of pregnancy, your pregnancy could be ectopic.

Pelvic Examination and Ultrasound

A doctor will perform a pelvic examination, an exam during which he or she inserts gloved fingers into the vagina and feels the abdomen with the other hand. A pelvic examination helps the doctor:

  • Find painful areas in your abdomen
  • Feel an enlarged uterus, which may indicate pregnancy
  • Check for masses in your abdomen

If an ectopic pregnancy is suspected, you'll probably also have an ultrasound. Ultrasound is an imagine technique that uses high-frequency sound waves to create a picture of the inside of the body. An ultrasound can show if a developing fetus is located outside the uterus. An ultrasound may not be able to find every ectopic pregnancy, however, especially if your pregnancy is less than six weeks along.

Laparoscopic Surgery

The final test for a definitive diagnosis of ectopic pregnancy is surgery. Usually surgery can be performed using a laparoscope, a thin instrument that is inserted through a small incision in the abdomen (often made through the belly button). The laparoscope has a camera attached so the surgeon can view the internal organs without making a large abdominal incision.

Laparoscopy is a relatively simple procedure performed under general anesthesia, and you can usually go home the same day. If the procedure locates an ectopic pregnancy, further surgery to remove the pregnancy or both the pregnancy and the fallopian tube may be performed at the same time, and can also be done laparoscopically.

Culdocentesis

A test called culdocentesis may be used to check for internal bleeding that can result from an ectopic pregnancy, although it is not performed very often. In this test, a needle is inserted into the space at the very top of the vagina (the passageway from the womb to the outside of the body), behind the uterus and in front of the rectum. Any blood or fluid drawn out by the needle may indicate an ectopic pregnancy.

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.