How Would I Know if I've Got an Ectopic?
Ectopics tend to present in one of three ways:
- As an emergency. Suddenly, without warning a woman is very unwell, collapses and is taken to hospital. A positive pregnancy test is found and she is transferred to theatre PDQ and a ruptured ectopic is found with bleeding into the abdomen.
- The second group are known to be at risk of an ectopic pregnancy, for example she may have had an ectopic previously, may have undergone tubal surgery or assisted conception (such as IVF). Early detection of ectopics are high in this group of women as we routinely check that the pregnancy is where it should be fairly early on. Less than 20% of ectopics present this way.
- Finally, the most common presentation is with a missed period, positive pregnancy test, some abdominal pain (usually to one side), and some irregular vaginal bleeding. Some women report fainting or shoulder-tip pain.
What Tests are Used to Diagnose Ectopics?
Obviously first of all a pregnancy test. If a sensitive urinary ELISA test is negative, then ectopic pregnancy is virtually excluded. This may be backed up with a blood sample being taken.
Vaginal ultrasound scan can reliably demonstrate a pregnancy in the womb from about 4.5 to 5 weeks onward. Once this is proven, an ectopic is once again virtually excluded (except in the case of the extremely rare heterotopic pregnancy). Sometimes scan can show an ectopic pregnancy clearly in the tube next to the womb.
Unfortunately, there is about an 11 to 14 day window when a pregancy test may be positive, but it is too early for ultrasound scan to confirm excactly where it is.
In this case, it is important to watch for changes in clinical signs, such as worsening pain, more tender on examination, fall in blood pressure, etc. This may mean staying in hospital until it is sorted.
We can also check the exact level of the pregnancy hormone (hCG). In a normal pregnancy, this should double every 48 to 72 hours; in an ectopic, it may climb at a lower rate or plateau. The clinical signs and blood tests guide who should undergo laparoscopy.
Laparoscopy means having a general anaesthetic. A telescope is placed into the abdomen and the tubes visualised. This is the 'gold standard' for diagnosing ectopics, but it isn't done for everyone because of the need for an anaesthetic, and the modest risks of the procedure.