Ruling out ectopic pregnancy is very important once a monthly flow is omitted.

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ETOPIC PREGNANCY 

Ruling out ectopic pregnancy is very important at the first instance of monthly flow omission. Ectopic Pregnancy also known as tubal pregnancy represents the demise of gestation and a threat to the woman’s life. Some 40 years back ectopic pregnancies were diagnosed after they had ruptured. However with the advent of high resolution transvaginal sonography combined with highly sensitive radio-immunoassay of beta subunit of human chronic gonadotropin, early diagnosis is possible in more than 95% cases in most developed centers. 

The benefit of early diagnosis is the reduction in the incidence of maternal mortality and morbidity and enhances tubal preservation. Early detection of pregnancy can be achieved as early as 10 days following ovulation using the ultra – sensitive serum assays for beta HCG. The concept of concept of discriminatory HCG zone has enabled early diagnosis of ectopic pregnancy to be managed medically with the use of methotrexate, potassium chloride, hyperosmotic glucose, prostaglandin and other sclerosing agents. This could be achieved by direct injection or by parenteral route. 

A single progesterone assay has been found to be predictive of an abnormal pregnancy but not specific for an ectopic pregnancy. A single serum progesterone value of 25ng/ml or more is strongly indicative of a normal intrauterine pregnancy. However, value of less than 15ng/ml suggest an abnormal pregnancy, ectopic or threatened abortion. 

Symptoms of ectopic pregnancy 

Just as the normal symptoms of pregnancy such as ;

Nausea

Vomiting

Breast tenderness

Fatigue

Interruption of monthly flow, ectopic pregnancies come with 

abdominal pain 

syncope as a result of hypotension caused by hypovolemia

lower abdominal discomfort

slightly  uterus enlargement, and when it has ruptured it comes with a shoulder tip pain. 

Blood discharge is flowing towards the diaphragmis noticed with diaphragmatic irritation. 

A combination of ultasonography and ultra – sensitive beta HCG will enable an intra-uterine pregnancy to be excluded.