Changes in tubal blood flow in evaluating ectopic pregnancy

Abstract

Ectopic pregnancy is not recognized in 5523% of all cases using state-of-the-art diagnostic procedures. In this study, blood flow in tubal arteries was measured using a transvaginal duplex Doppler ultrasonography system. A 3.5 MHz Doppler transducer coupled to a 5 MHz imaging transvaginal sector probe was used to depict flow characteristics in the tubal branch of the uterine artery. This was performed in 102 patients. There was a significant increase in the blood flow on the tubal gestation side (p < 0.0001; z = -4.08). This between-side difference was determined using qualitative frequency shift analysis. The mean reduction in the resistance index on the side with the ectopic pregnancy as compared to the contralateral side was 15.6%. These changes appear to be due to trophoblast invasion. Between-side differences showed no dependence on gestational age (between gestational weeks 4 and 12 postmenstruation). We compared these data with those from three control groups ('early viable intrauterine pregnancy', 'early intrauterine pregnancy failure', 'non-gravid state'). In all these control groups, the impedance to flow, expressed as 'resistance index', showed no significant between-side difference. All control groups had significantly higher mean resistance index values than the ectopic pregnancy side, but did not differ from the contralateral side of the ectopic pregnancy group. The advantages of this new method in diagnosing ectopic pregnancy are early detection, non-invasivity, and immediate results.

Transvaginal sonography in the management of ectopic pregnancy

“…Serum hCG analysis is positive in nearly all cases of EP (10, 1 l), but this analysis is not available on a 24-hour or even daily basis in most institutions. Color Doppler evaluation may be very helpful (12,13) but is also not widely available. Commercially available urinary pregnancy tests are reported to be positive in 99% of cases of EP (10) and were positive in all cases in our study.…”

Does transvaginal color Doppler sonography differentiate between developing and involuting ectopic pregnancies?

“…This is in agreement with results in more recent publications. [12][13][14]16 Finally, we want to emphasize that expectant management of ectopic pregnancies based on the parameters mentioned in this study can be undertaken only in that limited group of women with asymptomatic ectopic pregnancies with an adnexal mass. This restriction reduces the applicability of the model to those cases with a positive P-HCG level, an "empty uterus,'' or only an "adnexal mass" that is distinct from the corpus luteum.…”

Ultrasound for diagnosing acute salpingitis: a prospective observational diagnostic study

“…Standardised colour Doppler settings were used (frequency 6 MHz; power Doppler gain 50; dynamic range 10 dB; edge 1; persistence 2; colour map 1; gate 2; filter 3). Finally, blood flow velocities were measured in the uterine arteries, in the tubal arteries at the place where the tube leaves the uterus (Kirchler, et al, 1992) and in the wall of any adnexal mass. Angle correction was used when measuring blood flow velocities in the uterine arteries.…”