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128 Ectopic Pregnancy – Modern Diagnosis and Management

eradication of unsafe abortion and early treatment of pelvic infections and good quality

A high index of suspicion and up to date diagnostic methods, proper sex education, prevention of unwanted pregnancy, prevention and proper treatment of sexually transmitted infections will reduce the incidence of ectopic pregnancy. Ectopic pregnancy presents a major health problem for women of childbearing age. It is the result of a flaw in the human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity, which ultimately ends in death of the foetus. Without timely diagnosis and treatment, ectopic pregnancy can become a life-threatening situation. In addition to the immediate morbidity caused by ectopic pregnancy, the woman's future

Ectopic pregnancy should be considered a relevant public health indicator in developing countries. An overall picture of the capacity of a health system to deal with the diagnosis and treatment of emergencies especially in the field of obstetrics and gynaecology (Goyaux et al, 2003). Ectopic pregnancy remains a major cause of maternal mortality and morbidity as well as early foetal wastage in Nigeria and other developing countries (Okunlola et al, 2006, Makinde et al, 1990, Baffoe & Nkyekyer, 1991, Abdul, 1999, Elhelw, 2003). A classical ectopic pregnancy does not develop into livebirth. Ectopic pregnancy can be difficult to diagnose because symptoms often mimic those of a normal early pregnancy. The first warning signs of an ectopic pregnancy are often pain or vaginal bleeding. Ectopic pregnancies continue to be a significant cause of maternal morbidity, mortality, and reproductive failure in Nigeria (Faleyimu et al, 2008). Ipsilateral ectopic pregnancy occurs rarely and may be difficult to diagnose in low resource settings where there are no diagnostic tools especially vaginal ultrasound probe. When vaginal ultrasound probe is available, there are no trained medical personnel to operate such sophisticated equipments. There are few reported cases of ectopic pregnancy on a previous ectopic pregnancy stump. Ectopic pregnancy may pose a diagnostic dilemma where facilities are not available. In developed nations, treatment options have shifted from laparatomy to conservative surgical and non-surgical techniques. The availability of high-resolution ultrasonography with vaginal transducers in combination with the discriminatory zone of the beta subunit of human chorionic gonadotrophin has increased early diagnosis of the ectopic pregnancy in centres, which have such facilities (Ory, 1992). As the ability to diagnose ectopic pregnancy improves, physicians will be able to intervene sooner, preventing life threatening sequalae and extensive tubal damage, which could preserve future fertility. Already with improving technology, physicians are treating ectopic pregnancies with minimally invasive surgery or no surgery at all. Physicians have been able to reduce the mortality rate secondary to ectopic

Efforts to improve early diagnosis prior to tubal rupture however remain a great challenge in the developing countries and under equipped hospitals. The future fertility outcome is improved if the contra-lateral tube is normal. However, it is subjective to assess the normalcy of the tube by gross assessment since the pathology that usually predisposes to the ectopic pregnancy is intraluminal and may be present in the contralateral tube. Nevertheless, the practice of examination and documentation of the status of the contra-lateral tube during laparatomy for ectopic pregnancy is important. Late diagnosis leading to almost all cases of major complications and emergency surgical treatments are key elements accounting for such high fatality rates in women suffering

obstetric care will prove useful as preventive measures.

ability to reproduce may be adversely affected as well.

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**8** 

*China* 

**Clinical Application of One-Step Diagnosis for** 

*International Peace Maternal and Child Health hospital, Shanghai Jiaotong University* 

Suspected ectopic pregnancy (SEP) means a woman whose hemoperitoneum and pregnancy test are positive but the gestational sac is uncertain, which is finally diagnosed as an ectopic pregnancy (EP) or a hemoperitoneum with intrauterine pregnancy (hIUP). For emergency physicians, it is mostly important to differentiate EPs rapidly from hIUPs of which the vast majority can be managed without surgery. The combination of transvaginal ultrasound and serum HCG determination seem to be reliable for the early diagnosis of EP (Kaplan et al., 1996; Mol et al., 1998.). However, in most of the emergency rooms (especially on the night shift) in the general hospital, transvaginal ultrasound is often unavailable or instead of transabdominal ultrasound operated by a nonprofessional gynecologist in developing countries, which limits the prompt and accurate diagnosis of EP. Besides, the serial transvaignal ultrasound and HCG quantity result in a lot of workload for the gynecologist

A serum: cerebrospinal fluid (CSF) HCG ratio less than 40 is an accurate indication of the presence of brain metastases of gestational trophoblastic tumor, and may have considerable predictive value. However, false-negative serum: CSF HCG ratio (greater than 40) frequently occur in patients with proven brain deposits, and the cerebrospinal fluid puncture or lumbar puncture is difficult to perform for the gynecologist (Bakri et al., 2000.). Magnetic resonance imaging head scan, hence, is now preferred as the most sensitive and

Culdocentesis is the transvaginal passage of a needle into the posterior cul-de-sac in order to determine whether free blood is present in the abdomen. It is a simple procedure to determine whether there is intraperitoneal hemorrhage. It has been used less frequently in recent years because many gynecologists think it useless for the diagnosis of EP. In the light of the idea that serum: CSF HCG ratio is indication of the presence of brain metastases, making use of the simple operation of culdocentesis, we have proved that HCG ratio of hemoperitoneum versus venous serum (Rp/v-HCG) of EPs is apparently different from that of hIUPs (Wang, et al., 2010.). Hence, in order to provide a single-visit method for predicting EP from SEP, we want to prospectively further assess the diagnostic value of the Rp/v-HCG for early EP. Furthermore, we want to discuss the availability of Rp/v-HCG for rare EP such

safe technology available for brain metastases of gestational trophoblastic tumor.

and additional medical costs for the patients (Condous et al., 2005.).

**1. Introduction** 

as abdominal pregnancy et cetera.

**Ectopic Pregnancy by HCG Ratio:** 

Yu-dong Wang, Wei-wei Cheng and Xiao-ping Wan

**Hemoperitoneum Versus Venous Serum** 

