The diagnosis and management of ectopic pregnancy.

The increase in the number of women in whom a diagnosis of ectopic pregnancy is made presents challenges to the gynaecologist. It is important to follow diagnostic protocols to ensure that cases are not missed. But because diagnostic tools, such as the use of serum hCG estimations, improves pickup, clinicians need to be aware that surgery is not the only effective way of managing ectopic pregnancy and women can be offered management choices. Diagnosis of ectopic pregnancy is made by considering the clinical situation in conjunction with the ultrasound and biochemical (hCG or progesterone) findings. There is no test that conclusively proves that an ectopic pregnancy is present. Fetal fibronectin is explored as a possible diagnostic test as part of this thesis. Whilst there are appears to be some differences in the levels in different situations in early pregnancy, the assay, which detects the FDC-6 epitope of the fetal form of fibronectin and is in widespread use in later pregnancy, is fundamentally flawed, as it is not specific to the fetal form of fibronectin and detectable levels can be found in the cervixes of non-pregnant women, as the presence of blood leads to a positive result. It is not possible to show whether or not fetal fibronectin is a useful tool in the diagnosis of ectopic pregnancy with the available assay. A series of questionnaires were used to assess the availability of Early Pregnancy Units and women's experiences of the diagnostic and management of ectopic pregnancy. I demonstrated that women can weigh different choices, where the choices offer complex advantages and disadvantages, and value involvement of management decisions. An audit of the use of hCG estimations within St. James's University Hospital was used as a basis of a protocol for the management of ectopic pregnancy.