Exams and Tests

Most ectopic pregnancies can be detected using a pelvic exam, ultrasound, and blood tests. If you have symptoms of a possible ectopic pregnancy, you will have:

• A pelvic exam, which can detect tenderness in the uterus or fallopian tubes, less enlargement of the uterus than expected for a pregnancy, or a mass in the pelvic area.
• A pelvic ultrasound (transvaginal or abdominal), which uses sound waves to produce a picture of the organs and structures in the lower abdomen. A transvaginal ultrasound is the most dependable way to show where a pregnancy is. A pregnancy in the uterus is visible 6 weeks after the last menstrual period. An ectopic pregnancy is likely if there are no signs of an embryo or fetus in the uterus but hCG levels are elevated or rising.
• Two or more blood tests of pregnancy hormone (human chorionic gonadotropin, or hCG) levels, taken 48 hours apart. During the early weeks of a normal pregnancy, hCG levels double every 2 days. Low or slowly increasing levels of hCG in the blood suggest an early abnormal pregnancy, such as an ectopic pregnancy or a miscarriage. If hCG levels are abnormally low, further testing is done to find the cause.

Sometimes a surgical procedure using laparoscopy is used to look for an ectopic pregnancy. An ectopic pregnancy after 5 weeks can usually be diagnosed and treated with a laparoscope. But laparoscopy is not often used to diagnose a very early ectopic pregnancy, because ultrasound and blood pregnancy tests are very accurate.

Follow-up testing after treatment

During the week after treatment for an ectopic pregnancy, your hCG (human chorionic gonadotropin) blood levels are tested several times. Your doctor will look for a drop in hCG levels, which is a sign that the pregnancy is ending (hCG levels sometimes rise during the first few days of treatment, then drop). In some cases, hCG testing continues for weeks to months until hCG levels drop to a low level.

What to think about

If you become pregnant and are at high risk for an ectopic pregnancy, you will be closely monitored. Doctors do not always agree about which risk factors are serious enough to watch closely. But research suggests that risk is serious enough if you have had a tubal surgery or an ectopic pregnancy before, had DES exposure before birth, have known fallopian tube problems, or have a pregnancy with an intrauterine device (IUD) in place.¹

A urine pregnancy test—including a home pregnancy test—can accurately diagnose a pregnancy but cannot detect whether it is an ectopic pregnancy. If a urine pregnancy test confirms pregnancy and an ectopic pregnancy is suspected, further blood testing or ultrasound is needed to diagnose an ectopic pregnancy.