NOTE
Diagnosis of ectopic pregnancy is presumed when β-hCG titer >1,500 mIU. Failure to see a normal intrauterine gestational sac when β-hCG titer >1,500
mIU is presumptive diagnosis of an unruptured ectopic pregnancy. No
intrauterine pregnancy is seen with vaginal sonogram.
Management.
Ruptured ectopic. Diagnosis of a ruptured ectopic pregnancy is presumed
with a history of amenorrhea, vaginal bleeding, and abdominal pain in the
presence of a hemodynamically unstable patient. Immediate surgical
intervention to stop the bleeding is vital, usually by laparotomy.
Intrauterine pregnancy. If the sonogram reveals an IUP, management will
be based on the findings. If the diagnosis is hydatidiform mole, the patient
should be treated with a suction curettage and followed up on a weekly basis
with β-hCG.
Possible ectopic. If the sonogram does not reveal an IUP but the quantitative
β-hCG is <1,500 mIU, it is impossible to differentiate a normal IUP from an
ectopic pregnancy. Because β-hCG levels in a normal IUP double every 58
hours, the appropriate management will be to repeat the quantitative β-hCG
and vaginal sonogram every 2–3 days until the β-hCG level exceeds 1,500
mIU. With that information an ectopic pregnancy can be distinguished from
an IUP.
Unruptured ectopic. Management can be medical with methotrexate or
surgical with laparoscopy. Medical treatment is preferable because of the
lower cost, with otherwise similar outcomes.