Endovaginal sonography for the early diagnosis of intrauterine and ectopic pregnancies

Abstract

Endovaginal sonography, together with beta-HCG titre, was used to diagnose ectopic pregnancy in 58 patients. Transabdominal ultrasound failed to conclude this diagnosis. The data from endovaginal sonography revealed the presence of a gestational sac in all 15 patients with normal pregnancies at a beta-HCG level of 1042 mIU/ml. Of the 23 patients with pathological pregnancies only 61% had an intrauterine gestational sac. Only 15% of the 20 patients with ectopic pregnancies showed an increase in beta-HCG greater than 66% in 48 h, while in normal pregnancy, this increase was found in 71% of the patients. The endovaginal findings of the ectopic gestation revealed a complex adnexal mass in 55%, a cystic mass in 30% and fluid in the cul-de-sac in 20%. The diagnostic indices of adnexal and cul-de-sac sonographic findings in the ectopic group further improved specificity and positive predictive accuracy. The detection of ectopic versus intrauterine gestation showed a high sensitivity of 95%, a specificity of 100%, a positive predictability of 100% and a negative predictability of 97%. The data confirm the value and reliability of endovaginal and cul-de-sac sonography, combined with measurement of the beta-HCG level in the early diagnosis of ectopic pregnancy. This combined approach not only makes the differentiation between normal and extrauterine gestation more accurate but also helps to avoid unnecessary diagnostic laparoscopy and hospitalization.

Human Chorionic Gonadotropin Isoforms in the Diagnosis of Ectopic Pregnancy

“…With the advent of transvaginal ultrasound, the hCG cutoff has decreased to 1000 -2000 IU/L (12 ). Although the introduction of this hCG discriminatory zone appears effective, a particular hCG concentration has yet to be defined as a good diagnostic indicator for ectopic pregnancy (13 ).…”

A Case of Chronic Ectopic Pregnancy Manifested by Rectal Bleeding

“…An intrauterine pregnancy can be visualized using TVS with serum β -HCG levels as low as 1000 IU/L [9]. In cases of chronic ectopic pregnancy, serum β -HCG levels are usually much lower due to a very small amount of live villi [10].…”

Diagnostic Accuracy of Ultrasound Above and Below the Beta-hCG Discriminatory Zone

“…[1][2][3][4][5][6][7][8][9][10][11][12] This is the first study directly to evaluate and compare sensitivity, accuracy, and predictive value of ultrasound for diagnosing women with symptomatic early pregnancy on the basis of initial ␤-hCG values above or below an established discriminatory zone. A MEDLINE search of the English literature from 1966 to December 1998 using the search terms "ultrasound," "ectopic pregnancy," and "diagnosis" showed that all previous studies evaluated diagnoses of complications of early pregnancy in subjects with a ␤-hCG above the discriminatory zone or did not stratify results on the basis of initial ␤-hCG levels.…”

“…1,2 Ultrasound in conjunction with serum ␤-hCG concentrations is well established using a discriminatory zone. [5][6][7][8][9] Ultrasound alone has high sensitivity and specificity in diagnosing ectopic pregnancy in high-risk women. If ␤-hCG concentration is above the discriminatory zone, and an intrauterine sac is not seen, abnormal gestation or ectopic pregnancy is considered strongly.…”

“…[3][4][5][6] The ␤-hCG discriminatory zone is the level above which an examiner can be certain to see normal gestation, if present. 6,7,10,11 The increased resolution of ultrasound has improved detection of abnormal gestations including ectopic pregnancies. [5][6][7][8][9] Ultrasound alone has high sensitivity and specificity in diagnosing ectopic pregnancy in high-risk women.…”