The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery

Condous, G.; Okaro, E.; Khalid, Asma; Lü, Chuan; Huffel, Sabine Van; Timmerman, Dirk; Bourne, Tom

doi:10.1093/humrep/deh770

Cited by 272 publications

(214 citation statements)

References 12 publications

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“…A finding of any non-cystic adnexal mass by transvaginal sonogram had sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 100%, 94% and 100%, respectively [14]. If TVUS is non-diagnostic, the gestation may be too early to be visualized via ultrasound, in which case serial measurements of serum hCG concentration should be taken until the discriminatory zone is reached [15].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

OGIJ

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Background: During the first trimester of pregnancy, ectopic pregnancy is the leading cause of maternal mortality. Diagnosis and management of ectopic pregnancies require that health care providers maintain vigilance. Providing a variety of surgical and medical treatments at night can be challenging to the on call team in a teaching hospital. We present four cases of ectopic pregnancies managed over a 15 hour period by the night on call gynecology team.Cases: Case 1, 26-year-old women diagnosed with a ruptured ectopic pregnancy that required emergent laparotomy and blood transfusion. In Case 2, 27-year-old women underwent dilation, curettage and minimal invasive surgery of operative laparoscopy for ruptured ectopic pregnancy. In Case 3, a 24-year-old woman with unruptured ectopic pregnancy was treated with methotrexate. In Case 4, 35 yearold women underwent minimal invasive operative laparoscopy for unruptured ectopic pregnancy. Conclusion:Despite technological advances in early diagnosis of ectopic pregnancy with the use of transvaginal sonogram and serial β-HCG titers, patients still present to the emergency department with ruptured ectopic pregnancy necessitating acute surgical interventions. This is especially prevalent in inner city hospital catchment area where patients often wait until development of severe symptoms before presenting for medical care. Therefore, diagnosis of ectopic pregnancies warrens a high index of suspicion and treatment plans that are individualized, particularly to area of services with attention to patient compliance.

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Section: Discussionmentioning

confidence: 99%

Untitled

2016

OGIJ

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“…1 Though more than 90% of ectopic pregnancies are visualized on transvaginal ultrasound, false positive diagnoses account for about 5e6%. 2 Corpus luteum, bowel, paratubal cyst, hydrosalpinx, endometrioma and fibroid account for the false positive diagnoses of ectopic pregnancy. 3 The classic findings of ectopic pregnancy on MRI are lack of intrauterine pregnancy, hemoperitoneum, tubal mass, hematosalpinx and wall enhancement of the dilated fallopian tube.…”

Section: Diagnosis: Ruptured Ectopic Pregnancymentioning

confidence: 99%

Acute pelvic pain in female with ruptured ectopic pregnancy: Magnetic Resonance Imaging as problem solving tool

Indiran¹

2015

Tr J Emerg Med

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A 31 year old female was referred to our Magnetic Resonance Imaging (MRI) department with history of lower abdominal pain for three days. The patient had a history of irregular periods, with no definite period of amenorrhea. There was no history of bleeding per vagina. The ultrasound performed by the referring physician showed a complex right adnexal lesion abutting the uterus with no free fluid in the pelvis, prompting the physician to think of a broad ligament fibroid. Subsequently the patient tested mildly positive for urine gravindex. As the physician felt that ultrasound was not contributing to a proper diagnosis, MRI pelvis was requested to help solve the clinical problem. Blood sample was given for assessment of Serum human chorionic gonadotropin (beta hCG) level at this same time. MRI images are shown as Figs. 1e4.

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“…In a prospective study of 6621 consecutive women with an early pregnancy, 85% of whom presented with pain and/or bleeding, tubal pregnancy was correctly diagnosed with transvaginal ultrasound with a sensitivity 91% and a specificity of 99.9% [5]. The sensitivity and specificity of transvaginal ultrasound with regard to tubal pregnancy are shown in Table 1 [5][6][7][8][9]. The table shows that transvaginal ultrasound is an excellent method for confirming or excluding tubal pregnancy, but sensitivity and specificity are likely to depend highly on the skill of the examiner and on the quality of the ultrasound equipment used.…”

Section: Bleeding And/or Pain In Early Pregnancymentioning

confidence: 99%

“…In appropriately trained hands, a single transvaginal ultrasound examination can correctly confirm the presence of an intrauterine or ectopic 6 pregnancy in 90% of cases [4,5]. In a prospective study of 6621 consecutive women with an early pregnancy, 85% of whom presented with pain and/or bleeding, tubal pregnancy was correctly diagnosed with transvaginal ultrasound with a sensitivity 91% and a specificity of 99.9% [5]. The sensitivity and specificity of transvaginal ultrasound with regard to tubal pregnancy are shown in Table 1 [5][6][7][8][9].…”

Section: Bleeding And/or Pain In Early Pregnancymentioning

confidence: 99%

Imaging in gynecology

Valentin

2006

Best Practice & Research Clinical Obstetrics & Gynaecol

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This chapter summarizes the diagnostic performance (sensitivity, specificity, positive and negative likelihood ratios) of ultrasound, computer tomography, and magnetic resonance imaging in the diagnosis of various gynecological diseases and tumors. Positron emission tomography is not discussed. Imaging in infertility, in the diagnosis of Mullerian duct anomalies and in gynecological oncology (staging of gynecological cancers, diagnosis of recurrence of gynecological cancer, diagnosis of trophoblastic tumors) is not dealt with.Ultrasound is the first line imaging method for discrimination between viable intrauterine pregnancy, miscarriage and tubal pregnancy in women with bleeding and/or pain in early pregnancy, for discrimination between benign and malignant adnexal masses and for making a specific diagnosis in adnexal tumors (e.g., dermoid cyst, endometrioma, hemaorrhagic corpus luteum, ectetera), for diagnosing intracavitary uterine pathology in women with bleeding problems, and for confirming or refuting pelvic pathology in women with pelvic pain. Magnetic resonance imaging may have a role as a secondary test in the diagnosis of adenomyosis, 'deep endometriosis' (e.g., endometriosis in the rectovaginal septum or in the utero-sacral ligaments), and in the diagnosis of extremely rare types of ectopic pregnancy (e.g., in the spleen, liver or retroperitoneum).

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The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery

Cited by 272 publications

References 12 publications

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Acute pelvic pain in female with ruptured ectopic pregnancy: Magnetic Resonance Imaging as problem solving tool

Imaging in gynecology

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