The transvaginal approach has significantly improved the accuracy of ultrasonography for the detection of ectopic pregnancy. However, there has been limited emphasis given to determining the sensitivity of ultrasonography when a hematosalpinx was used as a specific finding to identify an ectopic pregnancy. The sensitivity of transvaginal ultrasonography was evaluated for the detection of a hematosalpinx defined as an "echogenic homogeneous or inhomogeneous, rounded or elongated structure" in a group of patients with surgically proven ectopic pregnancy. Retrospectively, transvaginal ultrasonography showed a hematosalpinx in 16 out of 18 (88.8%) tubal pregnancies. In 6/6 (100%) patients with a ruptured tube and 10/12 (83.3%) patients with an unruptured tube, a hematosalpinx was detected sonographically. A gestational sac with a live embryo was seen in 26.3% of these patients. The significance of identifying a hematosalpinx, predictability of rupture and implication in the treatment of ectopic pregnancy are discussed.
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