Technological advances have revolutionised the diagnosis and management of ectopic pregnancy, a century after Lawson Tail successfully performed a laparotomy to ligate the broad ligament and remove a ruptured tube in 1883. However, just as women are undergoing unnecessary surgery for men-orrhagia, most women in Britain who have an ectopic pregnancy undergo laparotomy despite the evidence in favour of laparoscopic or medical treatment. Ectopic pregnancy is a great masquerader. The clinical presentation varies from vaginal spotting to vasomotor shock with haemoperitoneum, making the accuracy of clinical diagnosis about 50%. Risk factors are present in 25-50% of patients and include a history of pelvic inflammatory disease, tubal surgery, or ectopic pregnancy; non-puerperal sterilisation; assisted reproduction; and the use of a progesterone (but not levonorgestrel or copper) intrauterine device. Thus, any woman of childbearing age who has abdominal pain, vaginal bleeding, or amenorrhoea with any of the above risk factors needs a urinary pregnancy te'st (for human chorionic gonadotrophin, sensitivity 98-100%) to ensure early referral for detection before rupture.
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