In resume, to diagnose a suspected or unruptured ectopic pregnancy, the history should be properly evaluated and a certain sequence of procedures followed. A biological test for pregnancy should be made, followed by pelvic examination under anesthesia. In the presence of a definite adnexal mass, no evidence of a blighted ovum on curettage and a positive test for pregnancy, a laparotomy may be performed forthwith. Otherwise, if there is still doubt, culdoscopy or surgical exploration of the posterior cul-de-sac should be performed, with subsequent treatment depending upon the findings. J.B. de Lee, 1933

Introduction

This chapter will describe other methods available for the diagnosis of ectopic pregnancy. In the western world, most of these methods have now been superseded by non-invasive biochemical and sonographic modalities.

5.2 Culdocentesis

Culdocentesis, whether pre- or intraoperatively, was widely used, particularly in the USA, to detect blood in the pouch of Douglas. With the patient in the lithotomy position, an 18 gauge needle is inserted through the posterior fornix and any blood/fluid present is aspirated. The test is rapid but painful. The test is positive if non-clotting blood with a haematocrit of more than 10% is obtained, negative if clear or blood-tinged fluid and non-diagnostic if no blood or fluid is obtained. In one study, 80% of patients with an ectopic pregnancy had a positive test, 2% had a negative result and in 16% the test was non-diagnostic (Romero et al., 1985).