Ectopic Pregnancy : Diagnosis

H&P , serial hCG levels , decreased progesterone levels , decreasing estradiol levels , increasing MSAFP , C-reactive protein and CA-125 levels , vaginal US , cureyyage , culdocentesis (+if ruptured but <20% will not be +) , laparoscopy (misses 2-4% due to being small plus risk and expense is increased).
If hCG fails to increase by at least 66% or > in 2 days --> a non-viable pregnancy should be assumed.
hCG<50% increase in 48 h --> abnormal pregnancy.
Abnormal pregnancy then hCG rises or falls very slowly and NO POC or pathology --> strongly suspect ectopic.
Serum progesterone:
<5ng/ml -->abnormal pregnancy
>25ng/ml --> lviable pregnancy
<15ng/ml --> most ectopics
Ultrasound diagnosis - sca can normally be seen with TVUS when hCG level is between 1000 and 2000 mlU/ml (first and second IRP).

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