Summary Ovarian follicular growth during the periovulatory period was measured using real‐time ultrasound in 33 patients during 53 spontaneous ovulatory cycles. The mean follicular diameter increased from 14·1 mm four days before ovulation to a maximum of 20·1 mm on the day of presumptive ovulation. The results correspond with previous static ultrasound studies of follicular development and in nine cycles in which both methods were employed the correlation between measurements on the same day was highly significant (r = 0·944; p <0.001). The day of ovulation could not be anticipated from a single measurement because of the relatively wide range of follicular size. Except in some obese subjects, real‐time ultrasound examination of the developing follicle appears to be a useful technique for assessing the progress of the ovarian cycle.

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The ultrasound findings from 260 patients with a clinical suspicion of ectopic pregnancy have been analysed and correlated with the results of urine pregnancy tests and tests of serum LH and/or HCG levels. Most importantly in a practical clinical context, it was found that a negative serum test virtually excludes an ectopic pregnancy, and an empty uterus with an adnexal mass and/or the presence of free fluid together with a positive urine test gives a very high probability of an ectopic pregnancy. The absolute diagnosis of an ectopic pregnancy by the demonstration of a living fetus outside the uterus is an uncommon finding (8%). Conversely, an empty uterus alone on ultrasound examination in the absence of other ultrasound findings in those patients with a positive serum test is not a reliable guide to the presence of an ectopic pregnancy unless there is an irrefutable conception date at least 5 weeks previously. It is recommended that pathology laboratories and ultrasound departments establish absolute levels of HCG above which an intrauterine pregnancy should always be visible within the uterus. Given appropriate attention to the clinical condition of the patient, the combined use of diagnostic ultrasound, simple urine pregnancy tests and serum assays of beta HCG levels goes a long way to discriminating between those patients with and those without an ectopic pregnancy.