Ectopic pregnancy.

Ectopic pregnancy is no longer dependent on laparotomy for definitive diagnosis. When patients present with massive hemoperitoneum, the diagnosis is usually obvious; but most patients do not present this way, so diagnostic aids are required. Culdocentesis is associated with unusually high false-negative and false-positive results. Laparoscopy is accurate but is an invasive procedure unwarranted in most cases for diagnosis. Although it is unusual to make the diagnosis of unruptured ectopic pregnancy by ultrasonography alone, when ultrasonography is combined with quantitative beta-subunit determinations of human chorionic gonadotropin, many ectopic pregnancies can be diagnosed before rupture occurs. The treatment of the woman with a ruptured ectopic pregnancy and in shock is immediate laparotomy and salpingectomy. Salpingostomy with removal of the ectopic mass and preservation of the tube may enhance a patient's subsequent fertility and may be useful in carefully selected women.