OC19.05: Non‐tubal ectopic pregnancies: ultrasound diagnosis, management options and clinical outcomes

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. OC19.04 Sonography of responsive versus non-responsive ectopic pregnancies

Ectopic low-lying implantation pregnancy: analysis of outcomes depending on gestation age

“…Rate of non-tubal ectopic pregnancies (EP) ranges from 5.0% to 10% from all EPs [1][2][3] though their overall incidence has been increasing in recent years [4]. Furthermore, non-tubal EPs contribute disproportionately to maternal morbidity and mortality in comparison to tubal EPs [2,3].…”

“…Unfortunately, in clinical practice the majority of clinicians have very limited experience and confidence in the differential diagnosis of this pathology and treatment is at the physicians' discretion [16]. Literature about non-tubal EP has been restricted to small case reports and series, with limited data on optimal treatment protocols [1].…”