# From Suspicion to Confirmation: An Original Study on a Complete Diagnostic Pathway for Ectopic Pregnancy

## TL;DR

This study outlines a complete diagnostic pathway for ectopic pregnancy, combining clinical, ultrasonographic, and histopathological findings to guide treatment decisions.

## Contribution

The study presents an integrated diagnostic approach for ectopic pregnancy, emphasizing the role of β-hCG dynamics and transvaginal ultrasonography in management decisions.

## Key findings

- Extrauterine ectopic pregnancies accounted for 63.3% of cases, with tubal ectopic pregnancy being the most common.
- Methotrexate therapy was effective in selected cases, as indicated by a ≥ 15% decline in serum β-hCG levels within 7 days.
- Transvaginal ultrasonography enabled accurate localization of ectopic implantation, aiding in individualized treatment.

## Abstract

Background/Objectives: Ectopic pregnancy (EP) remains a major cause of maternal morbidity. This study aimed to describe the clinical, ultrasonographic and histopathological features of EP, including changes following methotrexate (MTX) therapy. Methods: A retrospective analysis was conducted on 60 patients diagnosed with EP between 2018 and 2024. Clinical characteristics, serum β-hCG (beta-human chorionic gonadotropin) dynamics, treatment type, site-specific ultrasonographic features, and histopathological aspects were evaluated. Results: Extrauterine EPs accounted for 63.3% of cases, predominantly tubal ectopic pregnancy (T-EP), while uterine ectopic pregnancy represented 33.3%, including cesarean scar pregnancy (CSP) in 20%. Heterotopic pregnancy was identified in 3.3%. T-EP most frequently required surgical management, whereas MTX was effective in selected T-EP and CSP cases, as demonstrated by a ≥ 15% decline in serum β-hCG levels at 7 days. Transvaginal ultrasonography (TVUS) enabled accurate site-specific localization of ectopic implantation. Histopathological evaluation confirmed ectopic implantation and MTX-related changes in treated cases. Conclusions: Integrating clinical findings, β-hCG dynamics, and targeted TVUS allows accurate diagnosis and individualized management of EP, with histopathology providing definitive confirmation and insight into treatment-related changes.