Ectopic pregnancy early diagnosis limitations.

A series of 219 surgically and pathologic proven ectopic gestations are reviewed to emphasize the ectopic pregnancy early diagnosis limitations. A childbearing age, low parity woman is typical of having an ectopic pregnancy. Risk factors in their past history were absent in 52% of patients. Fertility investigations, IUD, PID, and abdominal surgery are often found in their past. Six per cent of patients had a previous ectopic pregnancy. Sixty-one per cent of patients were admitted with a definite ruptured ectopic pregnancy and 37% were admitted to rule out this condition. At surgery 58% had ruptured ectopic pregnancy with intraabdominal hemorrhage. Only 12% were unruptured. The obstetric outcome after surgery was available in 74 patients. Out of these, 40.5% had term pregnancies with live children, repeat ectopic pregnancy occurred in 8.2%, spontaneous first trimester abortion in 4.1%, and subsequent infertility in 16%. Postoperative pelvic adhesions were more frequently seen, at laparoscopy, when the patients were diagnosed at the stage of ruptured ectopic pregnancy with intraabdominal hemorrhage. A diagnostic protocol based on the screening of the patients at risk, correct evaluation of symptom and signs, and liberal use of beta-hCG pregnancy tests, culdocentesis, ultrasound and laparoscopy, is finally proposed.