<prompt> In ectopic pregnancy all are useful for diagnosis exceptCuldocentesisUSGBeta HCGFlat abdomen  <response>: Ans d Flat abdomen Ref Williams 22nd ed pg 259All except flat abdomen are useful for diagnosing ectopic pregnancy.Ectopic pregnancyCommonest site - AmpullaCommonest cause - PID SalpingitisOther causes - IUCD Progestasert- Tubal surgery- Adhesion following pelvic surgery- ARTPrevious ectopic -10 chance of recurrent ectopicModes of termination of tubal pregnancy--- Tubal abortion most common- Tubal rupture- Tubal mole- Continuation of pregnancyUterus in ectopic - Decidua without Chorionic villusArias- Stella reaction - Typical adenomatous change of endometrial glandsTubal mptureMost common in isthmic regionIsthmic mpture - 6-8wksAmpullary mpture - 8-12 wksInterstitial mpture - 16wksTriad- AmenorrhoeaAbdominal pain - Most constant feature of triadVaginal bleedingOther symptoms - Nausea, vomiting, fainting attacksInvestigation of choice - TVSAbsence of intrauterine pregnancy with a positive pregnancy testFluid in pouch of douglasAdnexial mass clearly separated from ovaryRarely cardiac pulsationOthers - beta HCG, laparoscopy, D CS. progesterone25mgml- Intra uterine 5mgml- AbnormalStudiford criteria - Primary abdominal pregnancySpiegelberg criteria - Ovarian pregnancyPaalman and Me Elin criteria- Cervical pregnancyDmgs used - Methotrexate KC1 Hyperosmolar glucose Ru-486. Indication for Methotrexate in ectopic pregnancy1 Patient haemodynamically stable2 Tubal diameter 4cm without cardiac activities3 Beta-HCG levelSurgery - Linear salpingostomy- Linear salpingotomy- Salpingectomy- Milking of tube 