title: Diagnosis of early ectopic pregnancy by measurement of the maternal serum to cul-de-sac fluid beta-hCG ratio.
abstract: In patients suspected of having an ectopic pregnancy, because of a positive beta-human chorionic gonadotropin (beta-hCG) test and a sonographically undetectable gestational sac, even laparoscopy cannot always achieve a precise diagnosis, when the gestational age is very early. This means that the patient has to be followed by repeated beta-hCG measurements and repeated laparoscopy, which are expensive and inconvenient for the patient. This paper reports on a method that is simple to perform and that will provide the clinician with valuable information about the strong likelihood of a tubal pregnancy when ultrasound and beta-hCG measurements raise the suspicion but are not diagnostic. A prerequisite for this approach is the availability of a minimal volume (1-2 ml) of peritoneal fluid in the pouch of Douglas. A total of 131 patients who had a positive beta-hCG test and an undetectable gestational sac within the uterine cavity and who had a small volume of cul-de-sac fluid were studied. The fluid was obtained transvaginally by means of an ultrasound-guided automatic puncture system. The beta-hCG level was determined in the cul-de-sac fluid and in the maternal serum, for comparison. In two cases with tubal pregnancy, concentrated viscous blood samples were aspirated and beta-hCG concentrations could not be measured for technical reasons. In 129 cases, the ratio of levels of beta-hCG between serum and cul-de-sac fluid could be measured. In 42 out of 44 patients with intrauterine pregnancy, the ratio was greater than unity; in 82 out of 85 patients with a tubal pregnancy, the ratio was less than unity. With this ratio used for detection of tubal pregnancy, the diagnostic sensitivity of the test was 95.4% and the specificity was 95.2%. The positive predictive value was 97.6% and the negative predictive value 91.3%. We conclude from these findings that the measurement of the maternal serum to cul-de-sac fluid beta-hCG ratio facilitated the early diagnosis of an ectopic pregnancy in the Fallopian tube.
authors.affiliation: Department of Obstetrics and Gynecology, University of Göttingen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Hinney
authors.forename: C
authors.initials: C
authors.lastname: Bertagnoli
authors.forename: M
authors.initials: M
authors.lastname: Tobler-Sommer
authors.forename: R
authors.initials: R
authors.lastname: Osmers
authors.forename: W
authors.initials: W
authors.lastname: Wuttke
authors.forename: W
authors.initials: W
authors.lastname: Kuhn
mesh_terms: D001202:Ascitic Fluid / Q000737:chemistry; D016022:Case-Control Studies; D006063:Chorionic Gonadotropin / Q000032:analysis* / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human; D003464:Culdoscopy; D004312:Douglas' Pouch; D005260:Female; D006801:Humans; D010446:Peptide Fragments / Q000032:analysis* / Q000097:blood; D011237:Predictive Value of Tests; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000175:diagnosis* / Q000453:epidemiology; D011677:Punctures; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal
chemical_list: D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments