LAPAROSCOPY - A DISPENSABLE TOOL IN THE DIAGNOSIS OF ECTOPIC PREGNANCY

Laparoscopy is regarded as the final decisive diagnostic test in suspe cted ectopic pregnancy. The new non-invasive diagnostic methods of tra nsvaginal sonography and serum human chorionic gonadotrophin (HCG) mon itoring now challenge this pivotal role of laparoscopy. In this prospe ctive study the diagnostic value of an algorithm, combining transvagin al sonography with an HCG cut-off level between 1000 and 1500 IU/l (IR P) was tested in 208 consecutive women at risk for ectopic pregnancy. Three diagnostic categories are designated by the algorithm: intra-ute rine pregnancy (n = 73), ectopic pregnancy (n = 89), and trophoblast i n regression (n = 46). The latter category represents patients in whom no pregnancy could be located by transvaginal sonography, with an ini tial HCG concentration <1500 IU/l, declining during follow-up. The alg orithm has a sensitivity of 0.97, a specificity of 0.95, a likelihood ratio for a positive test of 19.4, and a likelihood ratio for a negati ve test of 0.03. The described diagnostic strategy thus proved extreme ly reliable in the safe management of patients at risk for ectopic pre gnancy, and renders laparoscopy obsolete.