Diagnosis

A common clinical presentation of a woman with an ecto-pic pregnancy is the classic triad of amenorrhea, abdominal pain, and irregular vaginal bleeding. All women with these symptoms should be evaluated for possible ectopic gestation.

Serum quantitative hCG is often used to help identify those women with ectopic pregnancies. An isolated hCG level is not of much use unless it is above the threshold where one should visualize an intrauterine pregnancy with ultrasound. This threshold may vary depending upon type of hCG assay used and sonographic technique (Peisner and Timor-Tritsch, 1990). Two hCG levels drawn 48 hours apart are more informative. The general rule is a doubling of values in 48 hours. However, one must be careful to give pregnancies with a slow hCG rise every chance possible because they may turn out to be normal. A plateauing of hCG is consistent with an ectopic gestation or abnormal intrauterine pregnancy; ultrasound can be used to differentiate the two.

Serum progesterone levels are of some value in making the diagnosis of ectopic pregnancy (Stovall et al., 1989). A progesterone level less than 15 ng/mL is seen in 81% of ectopic, 93% of abnormal intrauterine, and 11% of normal intrauterine pregnancies. Less than 2% of ectopic pregnancies and less than about 4% of abnormal intrauterine pregnancies will have a progesterone level of 25 ng/mL or greater. Therefore a single progesterone value less than 15 ng/mL is probably an abnormal pregnancy and should prompt further evaluation. A single value greater than 25 ng/mL probably indicates a normal pregnancy.

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