Intended for healthcare professionals


Diagnosing suspected ectopic pregnancy

BMJ 2000; 321 doi: (Published 18 November 2000) Cite this as: BMJ 2000;321:1235

HCG monitoring and transvaginal ultrasound lead the way

  1. Willem M Ankum (, senior lecturer
  1. Department of Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands

    Ectopic pregnancy is an important cause of maternal deaths in early pregnancy. In the United Kingdom nine deaths were registered in 1991-3 and 12 in 1994-6. This raises the death rate from 0.3 to 0.4 per 1000 estimated ectopic pregnancies. Most fatal cases resulted from delayed diagnosis and inappropriate investigation and treatment despite the management of women with suspected ectopic pregnancy improving considerably during this period because of improved tools for diagnosis and management.1

    The first step forward in the diagnostic management of ectopic pregnancy was the introduction of laparoscopy in the late 1960s. This procedure solved the dilemma of prolonged clinical observation and the risk of performing an unnecessary laparotomy in suspected cases.2 Laparoscopy remained the only reliable method for diagnosing and excluding ectopic pregnancy until well into the 1980s. Around this time, …

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