Ectopic pregnancy (ectopic pregnancy) refers to the fertilization of an egg in any part of the uterus other than the normal body cavity. Ectopic pregnancy can be life-threatening, and as a common gynecologic emergency, it has always received widespread attention from clinicians. Ectopic pregnancy has become an epidemic worldwide, with about 2 out of 100 pregnancies in the United States being ectopic pregnancies. Nowadays, 80% of ectopic pregnancies can be diagnosed before rupture due to the widespread use of ultrasound, blood β-HCG measurement and the popularization of laparoscopic diagnosis. The diagnosis of ectopic pregnancy can be divided into four types: clinical diagnosis, auxiliary diagnosis, comprehensive diagnosis and laparoscopic diagnosis. Clinical diagnosis There is no difficulty in clinical diagnosis of ectopic pregnancy when miscarriage or rupture occurs with excessive intra-abdominal hemorrhage and typical symptoms and signs. However, these advanced cases are becoming less and less common nowadays, and are estimated to account for only about 20% of the cases. Early unruptured ectopic pregnancy is more common in clinical practice, and it is difficult to determine whether the pregnancy is pregnant and the location of the pregnancy by clinical examination alone. It is generally believed that the accuracy of diagnosing ectopic pregnancy by clinical examination alone is only about 50%. 2, auxiliary diagnosis (1) HCG measurement: normal pregnancy about 7 days after ovulation ~ 10 days after the beginning of HCG can be measured, the first three weeks of HCG secretion increases faster, about 1.7 days doubled; the fourth week ~ 10 weeks about 3 days doubled, 5 weeks of pregnancy when the blood HCG reaches more than 1,000 miu / ml, 8 weeks ~ 10 weeks of pregnancy to reach the peak. Dynamic observation of blood HCG level, 2 days should increase at least 66%. Ectopic pregnancy blood HCG level is low, doubling time (doubling time) prolonged for about 3 days to 8 days, the average 7 days. However, low HCG levels or prolonged doubling time are also seen in preterm or induced abortions. It should be noted that the half-life of blood HCG is 37 hours, so the blood HCG results do not reflect the activity of the trophoblast cells on the day the blood was taken. In addition, the measurement of blood HCG level often does not get results in a short period of time, which will prolong the time of diagnosis. Our department reported the trial of HCG rapid semi-quantitative plate method, which is fast and easy to detect the level of blood HCG, with high credibility, and can be detected at any time, which is very conducive to the early diagnosis of ectopic pregnancy and timely guidance for treatment. (2) Diagnostic imaging ultrasound diagnosis of ectopic pregnancy accuracy of up to 70% ~ 92.3%, its most important feature is that it can detect or exclude intrauterine pregnancy, if found to have intrauterine pregnancy, then the patient is very unlikely to have an ectopic pregnancy, because intrauterine and extrauterine composite pregnancy incidence rate is only 1:30,000, quite rare. The decisive significance for the diagnosis of tubal pregnancy is the “tubal ring” (tubal ring), ultrasound image is located outside the ovary 1cm~3cm diameter ring structure, wall thickness of about 2mm~4mm by the chorionic tissue and fallopian tube wall composed of reflections higher than the normal ovary or the corpus luteum of pregnancy, the center of the cystic anechoic area (gestational sac). (gestational sac). The specificity of tubal ring in the diagnosis of unruptured tubal pregnancy is 99.5%~100%. 86 cases of ectopic pregnancy were reported to have tubal ring visible on ultrasound. About 10%~20% of ectopic pregnancies have metaplasia changes in the endometrium and blood accumulation in the uterine cavity, and an elliptical liquid dark area called pseudo-gestational sac can be seen on ultrasonography. 5%~20% of gestational sacs, embryonic buds, and fetal heartbeat can be seen outside the uterus. The combination of ultrasound and blood HCG can improve the diagnosis of ectopic pregnancy. Blood β-HCG should be higher than 6500miu/ml when the gestational sac is seen on abdominal ultrasound, and higher than 2000miu/ml when the gestational sac is seen on vaginal ultrasound. If the blood β-HCG is higher than 6500miu/ml and no gestational sac is seen in the uterus, or if there is a cystic cavity in the uterus and the blood β-HCG is persistently lower than 2000miu/ml, ectopic pregnancy should be considered as a possibility. Vaginal ultrasound is superior in that the gestational sac can be seen at 5 weeks of gestation, and the ability to recognize ectopic pregnancy masses is higher than abdominal ultrasound. Color ultrasound of the endometrium and myometrium without limited blood flow increase also suggests the possibility of ectopic pregnancy, but also intravenous enhancement agents can be injected to make the ring around the trophoblast tissue easier to identify, to improve the sensitivity of ultrasound diagnosis. Some authors have reported that the accuracy of magnetic resonance imaging (MRI) in the diagnosis of ectopic pregnancy is high, but because of its high price, it should not be popularized. (3) Diagnostic curettage Because it is simple and easy to perform, it still plays an important role in the diagnosis of ectopic pregnancy. The main purpose of diagnostic curettage is to detect intrauterine pregnancy, especially abnormal pregnancies with poor development of trophoblast cells, low secretion of HCG and ultrasonography that does not find obvious gestational sacs, such as preterm or induced abortion. These types of pregnancies are clinically very similar to ectopic pregnancies and can be easily misdiagnosed as such, and doctors may treat them with MTX. However, MTX should not be used to treat intrauterine pregnancy and is not effective. Therefore, for patients with suspected ectopic pregnancy whose blood HCG level is less than 2000 miu/ml and who have a request for termination of pregnancy, diagnostic curettage should be carried out, and the scrapings should be sent to pathological examination after visual inspection; if chorionic tissue is found, it can be determined to be an intrauterine pregnancy, and no further treatment is needed. If no chorionic tissue is found in the scrapings, and the blood HCG level does not decrease significantly or continues to rise on the next day of the scraping operation, then ectopic pregnancy is diagnosed. (4) Posterior fornix or peritoneal puncture The misdiagnosis rate is about 10%. In developed countries, this test tends to be eliminated because ultrasonography is very common. In some hospitals in China, because of the lack of popularity of ultrasonography, the posterior fornix or abdominal puncture is still often used to assist in the diagnosis of internal bleeding in ectopic pregnancy. (5) Progesterone Determination Progesterone is relatively stable from 5 weeks to 10 weeks of pregnancy, and the level of ectopic pregnancy is low, and there is no correlation with the level of blood HCG. In recent years, many scholars at home and abroad believe that blood progesterone measurement is of great value in the diagnosis of abnormal pregnancies, including ectopic pregnancy, and its value is second only to that of blood HCG. e.g., progesterone at 8 weeks of pregnancy.