P04.16: Reassessment of the usefulness of transvaginal color Doppler ultrasound in the diagnosis of ectopic pregnancy

Abstract

Background: Cervical ectopic pregnancies (cEP) represent less than 1% of all ectopic pregnancies. Diagnosis of cEP is now based upon TVS findings rather than clinical presentation. As a result the vast majority of women presenting with cEP are stable and hazardous surgical intervention can be avoided. We report a series of seven cEP managed conservatively. Methods: A cEP was diagnosed on the following TVS criteria: the cervix was classically barrel-shaped, a gestational sac was present at the level of the uterine arteries, there was an absence of the sliding sign and colour Doppler flow around the sac demonstrated high vascularity. All women diagnosed with cEP had serum hCG levels taken at presentation. All but one woman was managed medically with methotrexate. Results: 7 cEP were diagnosed between 22.04.97 and 15.03.02. The mean gestation at presentation was 56 days (range 42-80 days). The mean hCG at presentation was 8188 IU/L (range 144-20967 IU/L). 4/7 presented with painless vaginal bleeding. 6/7 women were diagnosed with a cEP on the basis of their first ultrasound. 3/7 were successfully treated with a single dose of intramuscular methotrexate (50 mg/m2). 2/7 were given methotrexate 1 mg/kg days 1, 3 and 5 and leucoviron 0.1 mg/kg days 2, 4 and 6 (one was treated successfully whilst the other had a viable cEP and required TVS guided KCL injection into the sac). 1/7 was successfully managed expectantly and 1/7 was lost to follow up. The mean length of stay in hospital was 24 days (range 16-34 days) and the mean follow up time was 74 days (range 34-139 days). On average each woman had 4 ultrasound scans (range 2-8) and 15 serum hCG levels (range 8-23). Conclusion: In our experience, all women with cEPs can and should be managed conservatively. As the incidence of such pregnancies is low, it would be appropriate to refer all such women to a tertiary referral early pregnancy unit. P04.14 Case presentation of a unilateral live twin tubal ectopic pregnancy S. L. Lam KK Women's and Children's Hospital, SingaporeEctopic pregnancies represent a major health risk for women of reproductive age. If not treated properly, they can result in lifethreatening complications. Live twin ectopic gestations are extremely rare. There are more than 100 reported twin tubal pregnancies but only 6 have foetal cardiac motions demonstrated in both embryos. We describe an additional patient with live twin ectopic gestation. A 32 year old Chinese woman presented with amenorrhoea and 3 to 4 days of left iliac fossa pain without any vaginal bleeding. She had a past history of primary subfertility secondary to pelvic inflammatory disease and had therapeutic laparoscopy performed for blocked tubes. An endovaginal ultrasonogram showed no intrauterine gestational sac. A left adnexal ring echogenic mass containing 2 viable foetal poles were identified. These were later confirmed on surgery. Multiple factors are known to contribute to the relative risk of ectopic pregnancy and in this patient, these factors were previous pelvic inflammatory dis...