Whether a woman has a positive urinary pregnancy test or not, if she has ectopic pregnancy symptoms, good practice would then be to investigate with an ultrasound scan, ideally within 24 hours. The sonographer will scan across the abdomen (tummy) first but it is very likely that a transvaginal (internal) ultrasound scan will be required where a specialised probe is placed into the vagina to get a more detailed look at the reproductive organs.
If during the scan a pregnancy – that is a gestation (pregnancy) sac, a foetal pole and a beating heart – can be seen in the uterus, the chance of a coexisting ectopic pregnancy, whilst possible, is unlikely. In a case like this, bleeding may be implantation bleed, bleeding during a healthy pregnancy, or due to an impending miscarriage. Pain may be caused by a normal, healthy corpus luteum cyst, which forms on the ovary after ovulation, swelling to cause pain. Changes to the bowel and bladder may be attributed to hormonal changes, causing the woman to want to pass urine (wee) more often and possibly even be a little constipated (find it hard to open the bowels to have a poo).
If signs of pregnancy can be seen in the uterus, usually a yolk sac but either no embryo or if the embryo is too small to expect to see a heartbeat, this situation is given the medical label of an ‘Intrauterine Pregnancy of Uncertain Viability’ or PUV or IPUV. In this circumstance, you should be offered a repeat scan a week to ten days later to check whether the baby has developed a heartbeat.
This is an emotionally difficult time as it is not clear whether the dates for conceiving were wrong or whether the lady is likely to miscarry. Blood tests will also typically be taken to establish the level of hCG in the blood stream and again 48 hours later, to see how the levels are behaving.
If no pregnancy can be seen in the uterus, or there is a small gestation sac in the uterus without a yolk sac or embryo, the pregnancy will be medically labelled as a Pregnancy of Unknown Location or PUL. It is important to understand that PUL is not a diagnosis; it is a label given until the final location of the pregnancy can be identified with certainty. In the event of a PUL, blood will be taken to measure serum progesterone and hCG and the hCG test repeated 48 hours later. The doctors would also want to repeat the scan.
Until the location of the pregnancy is known definitively or the serum hormone levels have decreased to below pregnancy levels, there is a risk of complications associated with an as yet undiagnosed ectopic pregnancy. For every 100 pregnancies labelled as a PUL about 10 will subsequently be found to be ectopic; and not all of these will need treatment.
If no pregnancy can be seen in the uterus but there is evidence of free fluid in your abdomen and or a possible ‘mass’ in the approximate location of one of your fallopian tubes, the doctor would then be likely to diagnose a possible ectopic pregnancy. An initial scan will detect over 70% of ectopic pregnancies.