OC19.04: Sonography of responsive versus non‐responsive ectopic pregnancies

Abstract

Objectives: To assess if Doppler ultrasound improves the diagnostic accuracy of histologically confirmed RPOC. Examination of inter observer variability in diagnosis and measurement of RPOC. Methods: Retrospective analysis of and image review from ultrasound database of diagnoses of incomplete miscarriage in a tertiary referral early pregnancy unit from January to December 2014. Histological concordance was sought for those undergoing surgical management. Scan images were reviewed by two independent sonographers for accuracy of measurements and vascularity, including correct Doppler settings. Reviewers were blinded to the histological report. Results: A scan diagnosis of incomplete miscarriage was made in 699 cases of whom 117 underwent surgical management. A second procedure and repeat scan was required in 4 patients. 121 scans were reviewed. Histology confirmed RPOC in 115/121 (95%). Reviewer A disagreed with 45/121 (37%) and reviewer B 17/121 (14%) of measurements. In 8/121 (7%) of the same cases both reviewers disagreed with the original measurements. Measurements were overestimated. Power or colour Doppler was used in 96/121 (79%) cases. Reviewer A agreed with the operator's assessment of vascularity in 92/96 (96%) and reviewer B in 64/96 (66%) of scans. Vascular uptake subsequently assessed to be in the myometrium was the most common reason for disagreement. The original report concluded 15/96 (15%) of cases were avascular. Histology confirmed trophoblast in 13/15 (96%) of these. Conclusions:The diagnosis of RPOC remains subjective leading to unnecessary follow up and increased intervention rates with associated social disruption and management related complications for the patient. This dataset is being expanded to review images of all incomplete miscarriages, operation findings and histological measurements. Objectives: To assess the transvaginal sonography (TVS) findings of systemically treated ectopic pregnancies and to correlate these findings to changes in βhCG and clinical response. Methods: A retrospective analysis was performed of 30 women with ectopic pregnancies treated with systemic methotrexate (MTX) with pre-and post-treatment TVS. Patients were considered responsive to treatment if βhCG levels decreased by 15% of baseline 4-7 days following a single dose MTX. Patients were considered non-responsive if βhCG levels increased, or if a second dose of MTX or surgical intervention was required. Pre-and post-treatment images were evaluated for changes in ectopic size (increase defined as greater than 15% volume increase), vascularity and cul-de-sac fluid. OC19.04 Sonography of responsive versus non-responsive ectopic pregnanciesResults: Of the 7 responders and 23 non-responders, ectopic size increased in 57% of responders and 61% of non-responders. There was an increase in vascularity in 14% of responders compared to 39% of non-responders and a decrease in vascularity in 43% of responders compared to 35% of non-responders. Of the non-responders, increased vascularity was associated with a greater a...

The role of ultrasonography in methotrexate therapy for ectopic pregnancy

“…First observations of the evolution of EP vascularity following MTX therapy showed that in the majority of cases successfully managed with MTX therapy, an initial increase in the vascularity of the ectopic mass is observed and should not prompt concern (15) . Another study, however, demonstrated that increasing vascularity linked to a growing β-hCG level is found in cases unresponsive to MTX therapy, whereas in responsive cases the vascularity is seldom observed (17) . Thus, the significance of the changes in EP vascularity following MTX therapy has yet to be determined, with the most recent data pointing to the conclusion that a rise in the vascularity may be indicative of treatment failure.…”

“…Gamzu et al found that upon the administration of MTX, EP is observed to increase in size, which is not associated with a risk for treatment failure, and does not correlate with β-hCG level (16) . A recently published study suggested that the increasing EP size may even be considered a positive sign confirming the effectiveness of MTX therapy (17) .…”