Accuracy of transvaginal ultrasonography for detection of hematosalpinx in ectopic pregnancy

Abstract

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.

Effect of transvaginal sonography on the use of invasive procedures for evaluating patients with a clinical diagnosis of ectopic pregnancy

“…3,8 The presence of a large hemoperitoneum extending to the abdomen in a patient with a qualitatively positive serum ␤-hCG level and the absence of an intrauterine pregnancy was taken as strong indirect evidence of an EP.…”

“…[3][4][5] In fact, a study published in 1993 6 designed to evaluate the effect of TVS in the diagnosis of EP found that a substantial proportion of women with EPs have normal results on TVS at presentation: 23% in that series. That study found that TVS scanning is a notable improvement that has refined our ability to recognize intrauterine pregnancies, but in many cases, it does not lead to a confident diagnosis of EP.…”

Evaluation of prognostic value of Fernandez scoring system on the management of ectopic pregnancy in the emergency room at Suez Canal University Hospitals, Egypt

“…This agrees with the results of the study conducted by Atri M et al, in which 88.8% of the patients in the conservative group and 100% of the patients in the operative group had hematosalpinx in ultrasound. 26 And in this study, it was found that majority of the patients (90%) had hematosalpinx <1 cm in conservative and on the other hand (63.6%) of patients in operative group had hematosalpinx of 1-3 cm. And this difference is most probably due to increased gestational age and so increased size of the embryo.…”

Isolated torsion of hydrosalpinx

“…Haematosalpinx has been observed as an unusual complication after medical abortion with oral mifepristone with misoprostol. 4 Haematosalpinx has been reported in cases of ectopic pregnancy, 5 even bilateral ones in cases of unilateral ectopics. 6 In cases of gynaecologic and obstetric disorders presenting with abdominal pain, it is seen that usually the torsion of the adnexa is at the pedicle between the ovary and the uterus in twisted ovarian cysts.…”