Is there a difference in the behaviour and subsequent management of ectopic pregnancies seen at first scan compared to those ectopic pregnancies which commence as pregnancies of unknown location?

Lattouf, Ihab; Lü, Chuan; Pixton, Sarah; Reid, S.; Condous, G.

doi:10.1111/ajo.12434

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…We were unable to obtain histological confirmation of ultrasound and surgical diagnoses of EUEP in 4.9% of cases. This is in agreement with a previous study which stipulated that, in some women with spontaneous tubal miscarriage or rupture, the trophoblast may be lost within the large volume of blood clots 21 . Traditionally, the histological confirmation of trophoblast has been considered the reference standard for the diagnosis of EP 22 .…”

Section: Discussionsupporting

confidence: 93%

Effect of morphological type of extrauterine ectopic pregnancy on accuracy of preoperative ultrasound diagnosis

Dooley

Chaggar

Braud

et al. 2019

Ultrasound in Obstet & Gyne

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Objectives To assess the overall accuracy of transvaginal ultrasound (TVS) for diagnosis of all types of extrauterine ectopic pregnancy (EUEP) in a large group of women who were managed surgically. We also aimed to assess the positive predictive value (PPV) of TVS for each of the different ultrasound morphological types of EUEP. Methods This was a retrospective observational study of all pregnant women who underwent emergency surgery following ultrasound diagnosis of EUEP at a single early pregnancy unit between January 2009 and December 2017. The preoperative TVS findings were recorded, including the exact location and morphological type (Type I–V; defined using ultrasound criteria) of EUEP. TVS findings were compared with operative and histological findings. The performance of ultrasound in diagnosing EUEP overall and according to morphological type was assessed, using visual confirmation of ectopic pregnancy at surgery as the reference standard. Results A total of 26 401 women presented with early‐pregnancy complications during the study period, including 1241 (4.7%; 95% CI, 4.5–5.0%) women with a conclusive diagnosis of EUEP on TVS or a presumed diagnosis based on severe pain and significant hemoperitoneum. Surgery was performed in 721/1241 (58.1%; 95% CI, 55.3–60.8%) cases, of which 710 (98.5%; 95% CI, 97.6–99.4%) had a conclusive diagnosis of EUEP on preoperative TVS. The remaining 11 women had severe pain and significant hemoperitoneum and were managed surgically on clinical grounds as an emergency, without an ectopic pregnancy having been identified on ultrasound examination. At laparoscopy, the diagnosis of EUEP was confirmed in 706/710 (99.4%; 95% CI, 98.6–99.8%) women with a positive ultrasound diagnosis and in all 11 women with a presumed ultrasound diagnosis of EUEP. The PPV of preoperative ultrasound for the diagnosis of EUEP was 99.4% (95% CI, 98.6–99.8%) with sensitivity of 98.5% (95% CI, 97.3–99.1%). There was no statistically significant difference in the accuracy of preoperative ultrasound diagnosis between the five morphological types (P = 0.76). Conclusions The accuracy of preoperative ultrasound for diagnosis of EUEP is high. The morphological type of EUEP on TVS had no significant effect on the accuracy of preoperative diagnosis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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Section: Discussionsupporting

confidence: 93%

Effect of morphological type of extrauterine ectopic pregnancy on accuracy of preoperative ultrasound diagnosis

Dooley

Chaggar

Braud

et al. 2019

Ultrasound in Obstet & Gyne

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“…9 This is because these EPs are smaller and less symptomatic than EPs positively visualised on the first scan. 24,25 Our study has several limitations. The study was performed in a single centre and may not be representative of other centres.…”

Section: Discussionmentioning

confidence: 94%

The clinical outcome of pregnancies of unknown location: an audit of 112 cases

Lee

Nečas

2019

Sonography

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Introduction Pregnancy of unknown location (PUL) is a descriptive term applied when a woman presents with a positive pregnancy test but no signs of either intrauterine pregnancy (IUP) or ectopic pregnancy (EP) on ultrasound. This implies a level of diagnostic uncertainty requiring further investigation, with the main concern being an undetected EP. Method We examined the outcome of 112 pregnancies of unknown location (PUL) in a tertiary teaching hospital in New Zealand. Results Of 585 women referred to our service with a clinical suspicion of EP, 112 (19%) were categorised as PULs. The final outcomes in these women were complete miscarriage (52%), IUP (13%), presumed EP (11%), incomplete miscarriage (11%), confirmed EP (10%), and molar pregnancy (2%). A large proportion of women (42%) required a second ultrasound examination, and of those, 36% further required a third examination. The distribution of bHCG at presentation and symptomatology demonstrated considerable overlap in women with different clinical outcomes. Conclusion PUL continues to be a challenging and resource‐intensive clinical scenario. The rate of undiagnosed EP requiring intervention is around 10%, and the probability that a PUL represents a small nonvisualised ongoing IUP is relatively low (15%).

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“…About 75% of tubal pregnancies can be detected by transvaginal ultrasonography (3) , so sonography is considered as the mainstay for evaluating EP (2) . Different management strategies including expectant, medical, surgical management were recorded once diagnosis of TEP was confirmed on transvaginal ultrasonography (TVU) (4) . Treatment of ectopic pregnancy with methotrexate is effective for saving tubal patency with a tubal patency rate of 75% in hysterosalpingography (5) .…”

Section: Issn: 2320-5407mentioning

confidence: 99%

Laparoscopic Management of Tubal Ectopic Pregnancy: Single-Port Versus Conventional Multi-Port Laparoscopy.

kallaf¹

2018

IJAR

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Is there a difference in the behaviour and subsequent management of ectopic pregnancies seen at first scan compared to those ectopic pregnancies which commence as pregnancies of unknown location?

Abstract: EPs seen at the first ultrasound scan appear to be more symptomatic, larger in diameter and volume compared to EPs which started as PULs. Cumulative surgical intervention rate was noted to be higher in this group with EP seen on ultrasound at the outset.

Cited by 8 publications

References 17 publications

Effect of morphological type of extrauterine ectopic pregnancy on accuracy of preoperative ultrasound diagnosis

Effect of morphological type of extrauterine ectopic pregnancy on accuracy of preoperative ultrasound diagnosis

The clinical outcome of pregnancies of unknown location: an audit of 112 cases

Laparoscopic Management of Tubal Ectopic Pregnancy: Single-Port Versus Conventional Multi-Port Laparoscopy.

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