Retrospective analysis of effectiveness of transvaginal ultrasound in the detection of ectopic pregnancy

Česká verzia

Authors: B. Kubešová; P. Líbalová; V. Simonová; J. Bucharová; J. Záhumenský
Authors place of work: Gynekologicko-porodnická klinika 3. LF UK a FNKV, Praha, přednosta doc. MUDr. E. Kučera, CSc.
Published in the journal: Ceska Gynekol 2013; 78(4): 338-341

Summary

Objective:
To evaluate the effectiveness of transvaginal ultrasonographic (US) scan in own group of patients.

Design:
Retrospective analysis.

Setting:
Department of Gynaecology and Obstetrics, 3rd Faculty of Medicine, Charles University and Faculty Hospital Kralovské Vinohrady, Prague.

Methods:
We retrospectively evaluated the history, laboratory and ultrasound findings in a group of 115 patients, that have undergone a surgical procedure due to a positive diagnose or suspicion of ectopic pregnancy (EP). In all cases the diagnose of ectopic pregnancy was histologically confirmed.

Results:
67% of our patients were nulliparous, 10% of patients had a positive personal history of previous ectopic pregnancy, only 5% of pacients had a record of pelvic inflammatory disease in the past. Histological examination confirmed 96.5% (111/115) tubal, 1.7% (2/115) interstitial, 0.9% (1/115) ovarian and 0.9% (1/115) cervical ectopic pregnancy. Our transvaginal ultrasonography (TVUS) scan was successful in 76.5% (88/115). A pathological adnexal mass was visualised in 67% (77/115) cases. A negative ultrasound finding was observed in 23.5% (27/115) cases.

Conclusion:
The US detection of ectopic pregnancy by a single TVUS examination was successful in 76.5% (88/115) cases. Early detection of ectopic pregnancy by TVUS decreases the risk of rupture of different types of EP, decreases the rate of surgical interventions and also promotes conservative management of ectopic pregnancies.

Keywords:
diagnosis – ectopic pregnancy – transvaginal ultrasound – blob sign – bagel sign

Zdroje

1. Atri, M., Valenti, D., Bret, P. Effect of transvaginal sonography on the use of invasive procedures for evaluating patiens with a clinical diagnosis of ectopic pregnancy. J Clin Ultrasound, 2003, 31, p. 1–8.

2. Atri, M., Chow, C., Kintzen, G. Expectant treatment of ectopic pregnancies: Clinical and sonographic predictors. A J Roentgenology, 2001, 176, p. 123–127.

3. Barnhart, K., Mello, N., Bourne, T., Bottomley, C., et al. Pregnancy of unkonown location: A consensus statement of neomenclature, definitions and outcome. Fertil Steril, 2011, 95, 3, p. 857–866.

4. Barnhart, K., Speicher, D. Molecular diagnosis of ectopic pregnancy. Expert rev Mol Diagn, 2011, 11, 8, p. 759–762.

5. Bottomley, C., Belle, V., Mukri, F., et al. The optimal timing of an ultrasound scan to asses the location and viability of an early pregnancy. Hum Reprod, 2009, 24, 8, p. 1811–1817.

6. Casikar, I., Reid, S., Condous, G. Ectopic pregnancy: Ultrasound diagnosis in modern management. Clin Obstet Gyn, 2012, 55, 2, p. 402–409.

7. Condous, G., Okaro, E., Khalid, A., et al. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod, 2005, 20, 5, p. 1404–1409.

8. Fischerová, D., Pašková, A., Břešťák, M. Těhotenství neznámé lokalizace. In Calda, P., Břešťák, M., Fischerová, D. Ultrazvuková diagnostika v těhotenství a gynekologii. Praha: Aprofema, 2010, s. 428–432.

9. Fischerová, D., Břešťák, M., Zikán, M. Těhotenství neznámé lokalizace. Mod Gynek Porod, 2007, 16, 4, s. 649–659.

10. Jurkovic, D., Mavrelos, D. Catch me if you scan: ultrasound dia-gnosis of ectopic pregnancy. Ultrasound Obstet Gynecol, 2007, 30, p, 1–7.

11. Kirk, E. Ultrasound in the diagnosis of ectopic pregnancy. Clin Obstet Gyn, 2012, 55, 2, p. 395–401.

12. Kirk, E., Condous, G., Borune, T. Pregnancies of unkown location. Best Practice Res Clin Obstet Gynaecol, 2009, 23, p. 493–499.

13. Kirk, E., Papageorghiou, A., Condous, G., et al. The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy. Hum Reprod, 2007, 22, 11, p. 2824–2828.

14. Krajčovičová, R., Hudeček, R. Neradikální operační řešení cervikální gravidity po IVF/ET: kazuistika. Prakt Gyn, 2008, 12, s. 28–32.

15. Lin, E., Bhatt, S., Vikram, S., et al. Diagnostic clues to ectopic pregnancy. Radiographics, 2008, 28, p. 1661–1671.

16. Visconti, K., Zite, N. HCG in ectopic pregnancy. Clin Obstet Gyn, 2012, 55, 2, p. 410–417.