ABSTRACT
It used to be standard teaching that an ‘empty uterus with a positive pregnancy test is an ectopic pregnancy until proved otherwise’. This was based on transabdominal ultrasound findings and usually led to the patient being admitted for laparoscopy. We have seen in Chapter 2 that an intrauterine pregnancy can be visualized at a very early stage. However today if a pregnancy cannot be seen on transvaginal ultrasonography the situation is described as a pregnancy of unknown location (PUL) and the management is described in detail in Chapter 7. The diagnosis of a tubal ectopic pregnancy should instead be based upon the positive visualization of an adnexal mass using transvaginal ultrasonography (TVS). This does not require particularly sophisticated equipment and conventional two-dimensional grey-scale imaging alone is sufficient to make the diagnosis. Neither three-dimensional ultrasound nor colour Doppler is required. Although TVS has its obvious benefits, surgery should not be delayed in women who are haemodynamically unstable in order to confirm the diagnosis using ultrasound. Common sense must be applied and some patients will need to go straight to the
operating theatre on the basis of the clinical findings alone.
