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What is Most sensitive diagnostic test for ectopic pregnancy: and explain in detail?
Ans. (a) Transvaginal USGRef: D.C. Dutta 8th ed. / 212, Williams obst. 21st ed.l 892Diagnosis of Ectopic Pregnancy* Most definite diagnosis of pregnancy is by demonstrating intrauterine sac.* An absence of the intrauterine sac in a patient who is complaining of pain, bleeding and positive pregnancy test raise the suspicion of ectopic pregnancy.* By doing transvaginal UTZ, ectopic pregnancy can be ruled out. If the UTZ demonstrates live intrauterine fetus then ectopic pregnancy is very unlikely.* On the other hand, if the uterus is empty, an ectopic pregnancy can be diagnosed based on the visualization of an adnexal mass separate from the ovaries.* Beta-HCG also helps in diagnosis of pregnancy. It is positive in virtually 100% of ectopic pregnancies.* A positive test only confirms pregnancy and does not indicate whether it is intrauterine or extrauterine (ectopic).* In normal pregnancy beta-HCG should double up every 2 days but in ectopic pregnancy the rate of increase of beta HCG is slow.CULDOCENTESIS* Culdocentesis is the transvaginal passage of a needle into the posterior cul-de-sac in order to determine whether free blood is present in the abdomen.* This procedure will reveal non-clotted blood if intra- abdominal bleeding has occurred.* Clotted bloods signify ruptured ectopic pregnancy.* If culdocentesis is positive, laparoscopy or laparotomy should be performed immediately.