Early pregnancy diagnosis in sows by ultrasonic linear electronic scanning

A rapid and accurate technique for pregnancy diagnosis in sows has been developed. A portable ultrasonic linear electronic scanner was used in conjunction with 3.5 MHz multitransducers. The scanner employed ultrasonic waves to generate a two-dimensional image of an interior cross-section of an animal and the image was displayed on a TV monitor. The tip of the transducer was placed in contact with the lower flank of the standing sow about 5 cm posterior to the navel and just lateral to the nipple line directing toward the uterus. Results of tests conducted under controlled conditions on a farm, using 145 sows, proved that accuracy of the technique approaches 100% for diagnosing pregnancy from day 22 of gestation through term. The time of feeding before scanning did not affect the accuracy of pregnancy diagnosis.     

Measures of human olfactory perception during pregnancy

Although considerable anecdotal evidence suggests that pregnancy affects olfactory sensitivity, scientific evidence is limited and inconclusive. Whereas hedonic ratings are affected by pregnancy, odor identification is not. The aim of the current study was to examine odor perception in women across pregnancy and in the postpartum period. One hundred nonsmoking women who were pregnant, postpartum, or had never been pregnant were tested on the University of Pennsylvania Smell Identification Test (UPSIT). Intensity ratings and scratch patterns were collected as potential indicators of sensitivity, and participants rated the odors' pleasantness. Participants also rated their own sense of smell. Mean UPSIT scores did not differ significantly across groups indicating no difference in odor identification. Trends in planned comparisons suggested that in the first trimester, odors were rated as more intense and less pleasant. In the first trimester, women scratched the odor strips significantly fewer times. Consistent with previous reports, 90% of pregnant women reported that specific odors smelled less pleasant and 60% reported that some odors smelled more pleasant. Although nearly two-thirds of pregnant women rated their olfactory sensitivity to be enhanced during pregnancy and overall pregnant women's self-rated olfactory sensitivity was higher than controls', self-ratings were not correlated with UPSIT scores nor odor intensity ratings. These results suggest that these and previous findings may reflect the fact that the effect of pregnancy on olfaction is small and inconsistent.     

Improved diagnostic accuracy by repetitive ultrasonic pregnancy testing in sheep

Operator effects and instrument accuracy in using the Scanopreg ultrasonic pregnancy detector in sheep bred at synchronized estrus were studied in three experiments. In the first study, four operators tested the same 101 ewes at 60 and 80 days after breeding. The only significant difference among the four operators was that one operator consistently underestimated pregnancy. Operators did not differ in their diagnoses between days 60 and 80. In the second study, there were no differences between two operators who tested 239 ewes 90 days after breeding. In the third study, one operator tested 318 ewes 60, 70 and 90 days after breeding. The accuracy of diagnosis of pregnancy was at least 90% on each day tested; the corresponding diagnoses of nonpregnancy were 52, 76 and 79% correct. Some ewes that were initially diagnosed as nonpregnant were correctly recognized as pregnant when tested later than day 60. Most of the missed pregnancies were in ewes carrying a single lamb. A second Scanopreg test on day 90 of ewes not diagnosed pregnant on day 60 or 70 identified additional ewes as pregnant. Paired tests (days 70 and 90) recognized 99% of the ewes that eventually lambed.     

Early pregnancy diagnosis in sheep by progesterone and pregnancy-associated glycoprotein tests

The aim of this study was to compare the accuracy of the progesterone (P4) and pregnancy associated glycoprotein (PAG) tests for determination of early pregnancy in sheep. Estrus was synchronized in 182 Awassi x Merino ewes and blood samples were collected at Days 0 (day of the insemination), 18, 22, 29, 36, and 50 after artificial insemination (AI). Plasma P4 concentrations at Days 0 and 18 were determined by double antibody radioimmunoassay, while PAG concentrations at Days 22, 29, 36 and 50 were determined by a heterologous, double-antibody radioimmunoassay (RIA) using the bovine PAG 67 kDa subunit as tracer and standard and rabbit antiserum raised against a mixture of caprine 55 and 59 kDa PAG subunits as the first antibody. The discriminatory value for diagnosis of pregnancy by the P4 and the PAG-RIA tests was > or = 1 ng/ml. Based on lambing data, the accuracy for diagnosing pregnant (sensitivity) and non-pregnant ewes (specificity) and predictivity of both tests were calculated. The sensitivity, specificity, positive and negative predictive values for P4 and PAG tests were 100, 95.4, 81.6, and 100% at Day 18 (P4) and 93.5, 100, 100 and 98.7% at Day 22 (PAG), respectively. For diagnosis of non-pregnant ewes the PAG test had significantly higher specificity than the P4 test (P < 0.05). It is concluded that ovine pregnancy can be reliably diagnosed at Day 22 after AI by using a heterologous radioimmunoassay of PAG.     

The accuracy of enzyme-linked immunosorbent assay and latex agglutination progesterone test for the validation of estrus and early pregnancy diagnosis in dairy cattle

The accuracy of the enzyme-linked immunosorbent assay (ELISA) and the latex agglutination (LA) on-farm progesterone kit for detecting estrus and diagnosing early pregnancy was investigated in this study. Italian Friesian dairy cows (n=82) from 6 dairy herds were used for the collection of foremilk samples at the time of breeding and at 19, 21, and 23 days post insemination. Pregnancy status was ascertained by uterine palpation per rectum 40 to 60 days post insemination. Progesterone levels were affected by herd, percentage of milk fat, and the day of testing x diagnosis interaction. Validation of estrus by qualitative on-farm tests was 74.6% (LA) and 100.0% (ELISA) accurate using 0.5 ng/ml of progesterone as the RIA estimate for estrus. The accuracy rate for early pregnancy diagnosis by RIA was 68.4 to 83.8% for day 19 and day 21, respectively, while the detection rate for nonpregnancy was 84.6 to 100% on day 19 and day 21, respectively, as compared with uterine palpation per rectum. The average accuracy rate for early pregnancy diagnosis ranged from 84.7 to 92.3% for the LA and ELISA tests, respectively; the nonpregnancy rate was correctly predicted 93.9% to 68.2% for the LA and ELISA tests, respectively.     

Early pregnancy diagnosis in sheep using near-infrared spectroscopy on blood plasma

The objective of this study was to evaluate the ability of near-infrared reflectance spectroscopy (NIRS) to discriminate between pregnant and nonpregnant ewes in early stages of pregnancy after artificial insemination (AI) from blood plasma. Samples were collected using jugular puncture at 18 and 25 days after AI from 188 Rasa Aragonesa and Ansotana ewes. Plasma samples were analyzed for pregnancy-associated glycoprotein (PAG) and progesterone (P4) using ELISA commercial kits. The spectra of plasma samples were recorded in the visible and near-infrared ranges. The performance of these tests were compared, using as criterion standard the pregnancy status determined using transabdominal ultrasonography at 45 days after AI. Pregnancy rate was 47.9% (90/188). At Day 18, sensitivity was similar in NIRS and P4 tests (98.9% vs. 100%; not significant) and greater than PAG (32.2%; both P < 0.001). Specificity was similar in NIRS and PAG tests (both 100%) and greater than that of P4 (84.7%; P < 0.001). At Day 25, sensitivity and specificity of NIRS and PAG were both 100%. It can be concluded that NIRS was an accurate method of diagnosis of pregnancy at Days 18 and 25 after AI in ewes.     

Accuracy of ultrasonography and pregnancy-associated glycoprotein test for pregnancy diagnosis in buffaloes

The aims of the present study were to evaluate and compare the accuracy of transrectal ultrasonography and pregnancy-associated glycoprotein radioimmunoassay (PAG-RIA) test for diagnosis of pregnancy in buffaloes. Two hundred and seventy-five buffalo cows and heifers were examined once for pregnancy diagnosis by transrectal ultrasonography using a 5 MHz linear-array transducer between Days 19 and 55 after mating. After ultrasound scanning, a blood sample was withdrawn from jugular vein of each animal for measuring pregnancy-associated glycoprotein using a heterologous double-antibody RIA. Based on palpation of the uterus per rectum at Days 75-90, 87 animals were designated pregnant and 188 as non-pregnant. The sensitivity of transrectal ultrasonography at Days 19-24 was 44.4%, reaching 100% from Day 31 after mating. The specificity of transrectal ultrasonography ranged between 92.5 and 100% from Days 19 to 55 after mating. The sensitivity of PAG-RIA test was 11.1% at Days 19-24 and reached 100% from Day 31 after mating. The specificity of PAG-RIA test ranged from 90 to 100% from Days 19 to 55 after mating. There were no significant differences between the sensitivity and specificity of the two tests in all examined periods. In conclusion, transrectal ultrasonography and PAG-RIA test are highly accurate tests for detecting pregnant buffaloes from Day 31 after mating onwards.     

Transrectal real-time ultrasound scanning for diagnosing pregnancy and for monitoring embryonic mortality in dairy cattle

A total of 309 ultrasonographic tests was performed on 100 inseminated dairy cows during the course of the first trimester of pregnancy and on 13 noninseminated controls. The reliability (defined as the proportion of cows pregnant or nonpregnant by rectal palpation at 60–90 days compared to those diagnosed as pregnant or nonpregnant by ultrasonography) and accuracy (defined as the proportion of cows correctly identified as pregnant or nonpregnant) of the ultrasonographic results at different intervals after A.I., are reported. It was found that near 100% reliable results could be obtained for positive diagnosis from 45 days onwards and that the ultrasonographic results were 100% reliable for negative diagnosis from 40 days onwards. Furthermore, 7 out of 100 inseminated cows which were diagnosed as negative by early pregnancy diagnosis 21–24 days after A.I. were found to be positive at the ultrasonographic test after 30 days but interestingly enough failed to carry the conceptus until rectal palpation occurred (60 days). The total late embryonic mortality was 23%.     

Evaluation of different techniques for pregnancy diagnosis in sheep

Fifty Corriedale ewes were used in this study to evaluate pregnancy diagnosis in sheep. Ewes were bred under a pen mating system and pregnancy diagnosis was initiated from day 15 post-mating, applying the diagnostic techniques of trans-abdominal real-time B-mode ultrasonography, Preg-alert (A-mode ultrasonography), the Doppler ultrasonic fetal pulse detector or the plasma progesterone concentration assay (EIA). These tests were repeated fortnightly on all the ewes until the onset of lambing. The accuracy of trans-abdominal real-time B-mode ultrasonography (68%) at days 15–30 of pregnancy increased to 100% by days 61–75 and remained constant until lambing. The accuracy of the Preg-alert (56%) diagnosis at days 31–45 increased to 94% by days 91–105 of gestation and then decreased to 82% from days 136 of gestation to lambing. The accuracy of both the Doppler ultrasound (56%) at days 31–45 and plasma progesterone assay (98%) at days 15–30 of gestation increased to 100% at days 76–90 and 46–60 of gestation, respectively and remained constant until parturition. The mean plasma progesterone concentration at days 0–6 (1.41 ± 0.21 ng/ml) increased to 4.0 ± 0.87 ng/ml at days 16–30 (days 18.23 ± 0.78) post-mating. Animals returning to estrus recorded less than 1 ng/ml at days 18.23 ± 0.78 post-mating. The accuracy of both the B-mode ultrasonic technique (78%) and plasma progesterone assay (98%) was significantly higher (P < 0.05) than the accuracy obtained with the A-mode and Doppler ultrasound (both 56%) at days 31–45 of gestation. The study concluded that real-time B-mode ultrasonography is the earliest, most accurate, safest, fastest and most economical method of pregnancy diagnosis in sheep at farm level. The A-mode and Doppler methods can also be used under field conditions, where sophisticated laboratory facilities are not available. Plasma progesterone assays (EIA) can be used as a means of early pregnancy diagnosis in organized sheep farms with fair accuracy.     

A case of Cushing's syndrome in pregnancy

Cushing's syndrome (also known as hypercortisolemia) is rare in pregnant women due to the menstrual disturbances and infertility in women with hypercortisolism. A diagnosis of pathological hypercortisolism in pregnant women is often difficult as some symptoms of the disease may be associated with a complicated pregnancy. Hypercortisolemia leads to serious complications for mother and foetus, and is associated with premature labour and high foetal mortality. Hormonal and radiological diagnostics in pregnancy are limited. The results of hormonal measurements and dynamic tests are difficult to interpret due to the physiological changes in the hypothalamo-pituitaryadrenal axis connected with pregnancy. The optimal time and method of treatment should be chosen cautiously case by case because of the possibility of maternal and foetal complications. In this paper, we present a case of Cushing's syndrome secondary to adrenal adenoma in which the diagnosis was made in the 22(nd) week of pregnancy. Due to the advanced gestational status and mild symptoms of hypercortisolism, only symptomatic treatment was introduced. The patient was under continuous obstetric and endocrinological care. At 35 weeks of gestation, the pregnancy was terminated by emergency caesarean section because of premature detachment of the placenta. A male infant weighing 2,450 g was delivered; neither adrenal insufficiency in the child nor hypercortisolemia complications in the mother were observed.     

Accuracy of pregnancy specific protein-B test for early pregnancy diagnosis in dairy cattle

The objective was to evaluate the accuracy of an ELISA for pregnancy specific protein B (PSP-B) for early pregnancy diagnosis in dairy cattle. Blood from lactating (>100 d postpartum) dairy cows (n = 738), was collected on Days 28, 30, and 35 (Day 0 = estrus), analyzed with an ELISA for PSP-B, and the cows designated as pregnant, probable, unlikely, or non-pregnant. Immediately after blood collection, transrectal ultrasonography (TRUS) was done for pregnancy diagnosis, and the results used as a criterion standard test for comparison with PSP-B. At Day 28, 46.3% were diagnosed by TRUS as pregnant. The PSP-B sensitivity was 93.9% on Day 28 and similar on Days 30 and 35. The PSP-B specificity, positive predictive value, negative predictive value, and accuracy were all >94% on Day 28 and similar on Days 30 and 35. However, the accuracy was significantly less compared to TRUS (P < 0.01). The percentage of all samples from cows that were probably pregnant or unlikely to be pregnant was 5.6%. At Days 28, 30, and 35, percentages of uncertain samples were 8.5, 4.8, and 3.3%, respectively (P < 0.01), and Kappa values were 0.92, 0.92, and 0.95. False negative and false positive results were attributed to low concentrations of PSP-B in pregnant animals and to persistence of pregnant concentrations of PSP-B in females with pregnancy loss, respectively. In conclusion, PSP-B ELISA was a sensitive, specific, and accurate test for pregnancy diagnosis (relative to TRUS) at Days 28, 30, and 35 after breeding.     

Influence of management factors on pregnancy attrition in dairy cattle

The present study was conducted to determine the influence of management factors on pregnancy attrition in dairy cattle. Data from 3162 diagnosed pregnancies in parous cows and 1050 in heifers at 9 commercial dairy herds in northeastern Spain were used. Pregnancy diagnosis by palpation per rectum was performed from 30 to 70 d post insemination. Pregnancy attrition was registered when pregnancy diagnosis resulted negative in a second palpation carried out between 120 and 150 d following insemination. Overall proportion of pregnancy losses was 7.9% (9.6% in parous cows and 2.8% in heifers). Data analysis was performed by multiple logistic regression methods. For all animals, effect of time of pregnancy diagnosis was shown (Odds ratio = 0.97 for 1 d increase; P = 0.0042). Conceptus loss in heifers was lower than in parous cows (Odds ratio = 0.28; P = 0.0001), and a higher proportion of pregnancy attritions was detected in animals inseminated in spring, summer and winter, compared to those inseminated in autumn (P < 0.04). Herd effect on pregnancy attrition was also significant. Similar results were observed in the subanalysis for parous cows and, furthermore, no effect of lactation number and of interval from previous calving to pregnancy was shown in this group. In heifers, no effect of time of pregnancy diagnosis and of insemination season on pregnancy attrition was shown, and only a herd effect was observed. Our data suggest that the influence of parity status (heifer vs cow) could affect the proportion of pregnancy attrition rather than early diagnosis, and, in pregnant cows, adaptation to seasonal changes associated with temperature decreases seem more efficient.     

Effect of resynchronization with GnRH on day 21 after artificial insemination on pregnancy rate and pregnancy loss in lactating dairy cows

The objectives of the present study were to determine the effects of resynchronization with GnRH on Day 21 after artificial insemination (AI) on pregnancy rate and losses of pregnancy in lactating dairy cows. Holstein cows (n=585) on two dairy farms were assigned to one of two treatments in a randomized complete block design. On Day 21 after a pre-enrollment AI, animals assigned to the resynchronization (RES) group received 100 microg of GnRH i.m., whereas animals in the control (CON) group received no treatment. All animals were examined ultrasonographically on Days 21 and 28 after AI, and blood samples were taken for progesterone measurement on Day 21. Pregnancy was diagnosed on Day 28 and reconfirmed 14 days later. Nonpregnant cows on Day 28 were inseminated using timed AI after the completion of the Ovsynch protocol 10 and 17 days after enrollment in the study for RES and CON groups, respectively. Progesterone concentration > or =2.35 ng/ml was used as an indicator of pregnancy on Day 21. For RES and CON cows, pregnancy rate at Days 21 (70.9% versus 73.0%, P<0.56), 28 (33.1% versus 33.6%; P<0.80) and 42 (27.0% versus 26.8%; P<0.98) after the pre-enrollment AI did not differ. Administration of GnRH on Day 21 after AI had no effect on pregnancy loss in RES and CON groups from days 21 to 28 (53.2% versus 53.5%; P<0.94) and days 28 to 42 (17.9%; P<0.74) after AI. Pregnancy rate after the resynchronization period was similar for both treatment groups. Resynchronization with GnRH given on Day 21 after AI for initiation of a timed AI protocol prior to pregnancy diagnosis does not affect pregnancy rate and pregnancy loss in lactating dairy cows.     

Effect of post-insemination supplementation with PRID on pregnancy in repeat-breeder Holstein cows

Embryonic mortality contributes to repeat-breeding in dairy cows; luteal insufficiency is a known cause of embryonic mortality. The objective of this study was to assess the efficacy of supplementation with exogenous progesterone for 14 days on pregnancy maintenance in inseminated repeat-breeder dairy cows. On Day 5 after insemination, treated cows ( n=143 ) received a modified PRID (i.e. without estradiol capsule), which was removed on Day 19. Control cows ( n=148 ) did not receive any treatment. Overall there was no effect of PRID supplementation on pregnancy rates. However, when the study population was stratified by parity and stage of lactation, PRID supplementation significantly improved pregnancy rate in first and second parity late lactation cows (risk ratio = 3.26; 95% CI 1.22, 8.69). Pregnancy rates did not differ between PRID-treated cows with ( n=81 ) and without vaginitis. Control cows tended ( P=0.077 ) to have a higher proportion of abortions than PRID-treated cows (7/50 versus 2/51, respectively). In conclusion, young late lactation repeat-breeder cows benefited from progesterone supplementation, in terms of maintaining pregnancy until traditional time of pregnancy diagnosis.     

Serum progesterone levels as an index of pregnancy in buffaloes

Higher levels of serum progesterone on the 20th or 23rd day following impregnation were indicative of establishment of pregnancy in buffaloes. Buffaloes with serum progesterone levels of 1 ng/ml or more on these days were taken as pregnant. The accuracy of this test for diagnosing pregnancy was 75% on the 20th and 83.3% on the 23rd day after artificial insemination. The non-pregnancy diagnosis by this test was 100% accurate on both days of the test. Subclinical endometritis and/or early embryonic deaths seem to interfere with the exact diagnosis of pregnancy.     

Gynecological examination and pregnancy diagnosis in small ruminants using bimanual palpation technique: a review

A palpation technique using both hands was developed by the author and used for examination of internal reproductive organs, pregnancy diagnosis, and assessment of approximate stages of gestation in small ruminants. The study was conducted in 4 stages on 87 female goats and 30 slaughterhouse source ewes First, 20 doelings and 15 does with no recent history of insemination were examined by two hand method for palpability and structural integrity of internal reproductive organs. Next 52 goats (28 doelings and 24 does) were examined at 28 to 30 d post insemination for pregnancy. Among those diagnosed pregnant, 20 goats were examined at 15 d intervals to assess the palpable changes of pregnancy. Preslaughter palpation followed by post-slaughter verification of the findings were performed in 30 ewes. The two hand method was effective for palpating the reproductive tract in the nonpregnant goats irrespective of parity status. Gross palpation of the ovaries was possible in 83% of the goats. Of the 52 goats examined for pregnancy at 28 to 30 d, 29 (56%) had clear distension of uterus while 23 (44%) did not. The results were confirmed by kidding date or returning to service. Changes of the reproductive tract were monitored in 20 goats at biweekly intervals and the findings categorized by the stage of gestation. Post slaughter verification of preslaughter findings based on two handed palpation indicates that this technique can be used for early pregnancy diagnosis and assessment of the stage of gestation in goats and ewes.     

The use of radioreceptor assay for the detection of pregnancy in the mare

Jugular blood samples were collected between 42-45 days from the last breeding for measurement of pregnant mare serum gonadotropin (PMSG) and progesterone in 46 pregnant mares. A radioreceptor assay (RRA) was developed to measure human chorionic gonadotropin (hCG) and subsequently modified to measure PMSG. Highly purified hCG was iodinated using a lactoperoxidase enzymatic procedure and served as the labeled antigen for both the hCG and PMSG RRA. Standard curves were generated using purified hCG or PMSG. Bovine corpora lutea served as the receptor source. The assay was conducted at 37 degrees C for one hour with a total elapsed time from preparation of the luteal cell homogenate until final results were calculated of 2.5 hours. Twelve of the 46 mares failed to maintain their pregnancy, returned to estrus and reovulated after 45 days post-breeding (non-foaling mares). Thirty-four of the 46 mares delivered foals following a gestation of normal length. Mean concentrations of PMSG in the foaling mares was higher than in non-foaling mares. A concentration of 6.9 I.U. of PMSG/ml was used as the lowest concentration necessary for the confirmation of pregnancy. Five of the mares delivering foals had low concentrations of PMSG and were called non-pregnant. Thus, the incidence of false negatives by RRA was 14.7%. All of the non-foaling mares were correctly diagnosed non-pregnant for an error rate (false positive) of 0.0. Mare Immunological Pregnancy (MIP) tests on the 12 non-foaling mares indicated three false positives - an error rate of 25%. Of the 34 foaling mares, the MIP test indicated 8 inconclusive or false negatives, an error rate of 23.5%. At day 42-45, there was no significant difference in progesterone concentrations (determined by RIA) between foaling and non-foaling mares. RRA is a quick, accurate and quantitative method for measuring PMSG in the mare and can be used to diagnose pregnancy at 42-45 days post-ovulation. Plasma progesterone concentrations at this time were not associated with subsequent pregnancy maintenance as were plasma PMSG concentrations.     

Plasma progesterone concentrations during early pregnancy in spring- and autumn-bred ewes

The objective of this experiment was to measure blood progesterone concentrations during early gestation to determine if the apparent reproductive failure in ewes bred out-of-season is due to a failure to conceive or embryonic loss. Blood samples were collected from spring- (n=61) and autumn-bred ewes (n=29) from Days 8 to 39 post-oestrus. Serum progesterone concentrations were analysed to ascertain whether ewes were ovulating and failing to maintain pregnancy, or conception was failing. Following pregnancy diagnosis 62 days after ram introduction, ewes were categorised as; no display of oestrus, mated but then identified as non-pregnant, or pregnant. A majority of spring-bred ewes that failed to display oestrus had silent oestrus (86%) and 66% of those ewes had abnormally short-lived corpora lutea. Circulating progesterone concentrations during dioestrus in ewes that had ovulated and displayed oestrus were unaffected by season. Similarly, progesterone concentrations during dioestrus did not differ between pregnant and mated non-pregnant ewes. The results indicated that while early luteylosis, low progesterone secretion from corpora lutea and embryo mortality did occur, these were in only a small proportion of ewes. Progesterone concentrations indicated that a majority of mated non-pregnant ewes had elevated progesterone concentrations necessary for the production of at least one viable embryo/foetus. This may be indicative to the failure of maternal recognition of pregnancy, and it is recommended that events surrounding this stage of pregnancy (Days 12-14) be examined more closely in ewes during the non-breeding season.     

Improvement of early pregnancy diagnosis based on milk progesterone by the use of progestin-impregnated vaginal sponges

Progestin-impregnated (250 mg medroxyprogesterone) vaginal sponges (PIVS) were inserted 6-7 days post-insemination and removed on the 17th day. Pregnancy was determined by milk progesterone on the 21-24 day post-insemination. It was found that in 52 cows which did not receive PIVS, the rate of false diagnosis of pregnancy was 21%. In 30 cows treated with PIVS, there were no false positives. The diagnosis of non-pregnant was completely accurate in both groups.     

Ectopic pregnancy; early diagnosis,clinical errors and conservative operation

This report of eight years' experience with extrauterine pregnancy by a single gynecologist is an exposition of how the diagnosis was made or why it was missed. Of 26 diagnoses of ectopic pregnancy, five were false (20 per cent); and in three cases (10 per cent) the diagnosis was not made promptly-a total error of 30 per cent. Ectopic pregnancy will be discovered earlier if obstetric patients are always examined shortly after missing the first menstrual period.A palpable adnexal mass was present in 19 of 21 ectopic pregnancies (90 per cent). A mass was palpable in only one of five cases erroneously diagnosed as ectopic pregnancy (20 per cent).Decidual casts were passed by four patients, two of whom did not have ectopic pregnancy. If two gynecologists do not agree on the question of extrauterine pregnancy, a third opinion should be sought or culdoscopy employed. Enucleation of the conceptus and salvage of the oviduct is advocated.