How ectopic pregnancy is diagnosed
Ectopic pregnancy can be notoriously difficult to diagnose. The reason for this is that the condition can often present with symptoms which can be suggestive of other more usual conditions, such as gastroenteritis, miscarriage or even appendicitis.
Doctors rely on women to give them clear histories about their symptoms. The more you can tell a doctor about what has changed, what feels different and what is worrying you, the more likely they are to be able to diagnose you.
EPT advice is that all women of childbearing age presenting with abdominal pain and or bleeding, should be considered pregnant until proven otherwise. Good practice would be to investigate with a baseline ultrasound scan followed by beta hCG blood tests, 48 hours apart, if the scan is inconclusive.
Doctors are at liberty to follow their own hospital protocols and in the UK if they use any national guideline at all, it will be Greentop Guideline 21. The management of tubal pregnancy.
Diagnosis in hospital is improving all the time, particularly because more and more district trusts are setting up Early Pregnancy Assessment Units. Modern transvaginal (TVS) ultrasound scans on modern equipment provide better images than a few years ago, and repeated use of sensitive blood pregnancy tests (hCG) can help tell doctors how the pregnancy is progressing, even if your urine pregnancy test (standard GP or chemist urine test) is not positive or has stopped being positive.
Early pregnancy assessment usually involves an ultrasound scan as the baseline observation. If at this point a pregnancy can be seen - that is, a pregnancy sac, with halo, a foetal pole and a beating heart - the chance of a coexisting ectopic pregnancy, whilst possible, is very slim.
If signs of pregnancy can be seen in the uterus, a yolk sac but no viable foetus, then the doctors will want to rescan you, usually in a week’s time. The doctor would normally ask that your blood be taken, to establish the level of hCG in the blood stream, and again 48 hours later to see how the levels are behaving.
If no pregnancy can be seen in the uterus, the doctors will want to rescan you, usually in a week’s time. Blood will normally be taken, to establish the level of hCG in the blood stream and again 48 hours later, to see how the levels are behaving.
In both these cases above, you will be diagnosed with a pregnancy of unknown location (PUL). This is the point at which the doctor will be relying on the woman to be vigilant.
If no pregnancy can be seen in the uterus but there is evidence of free fluid in your abdomen and or a 
possible mass in the approximate location of one of your fallopian tubes, the doctor would then be likely to diagnose a possible ectopic pregnancy.
If you are stable, your pulse and blood pressure are within normal limits and you are not bleeding heavily or in severe pain and if you do not have signs of dizziness or fainting, the doctor will discuss the treatment options with you.
More information on treatment can be found here.
Unfortunately, a number of women present for assessment after a time when there are options for treatment. If you are bleeding heavily, in severe pain or have signs of dizziness or fainting, the doctor will probably suggest an exploratory surgical operation called a laparoscopy which done via keyhole to allow him or her to take a look inside your abdomen to see what might be happening.
If this is the case, the doctor will need to obtain your consent for the exploratory operation and at the same time will discuss with you the need to do a more involved surgical procedure if he or she finds an ectopic pregnancy.
