Transabdominal and Transvaginal Ultrasonographic Diagnosis of Ectopic Pregnancy: Clinical Implications

Valenzano, Mario; Anserini, Paola; Remorgida, Valentino; Brasca, A.; Centonze, Anna; Costantini, Sergio

doi:10.1159/000293092

Cited by 15 publications

(8 citation statements)

References 8 publications

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“…11,19 Transvaginal ultrasonography also allows better characterization of this fluid. 7 Caution should be taken when trying to characterize fluid on transabdominal examinations.…”

Section: Discussionmentioning

confidence: 99%

“…Transabdominal and transvaginal ultrasonography play key roles in the evaluation of patients with suspected ectopic pregnancy. [1][2][3][4][5][6][7][8][9][10][11] Intrauterine and extrauterine findings are important in both the exclusion and the diagnosis of ectopic pregnancy. Identification of an IUP, whether normal or abnormal, essentially excludes the diagnosis of ectopic pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Although transabdominal ultrasonography still plays an important role in the evaluation of ectopic pregnancies, 8 transvaginal ultrasonography is superior in the detection of small amounts of free fluid. 11,19 Transvaginal ultrasonography also allows better characterization of this fluid. 7 Caution should be taken when trying to characterize fluid on transabdominal examinations.…”

Section: Discussionmentioning

confidence: 99%

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Free echogenic pelvic fluid: correlation with hemoperitoneum.

Sickler

Chen

Dubinsky

et al. 1998

Journal of Ultrasound in Medicine

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ransvaginal ultrasonography has proven to be a valuable modality in evaluation of women with suspected ectopic pregnancy. [1][2][3][4] Its value lies not only in the near exclusion of ectopic pregnancy by identification of an IUP but also in the diagnosis of an ectopic pregnancy by recognition of key adnexal findings. Transvaginal ultrasonography enables the detection of extrauterine living embryos, tubal rings, complex masses, and free pelvic fluid.Pelvic fluid is an important extrauterine finding in the evaluation of a possible ectopic pregnancy. The identification of moderate to large amounts of fluid has been shown to correlate with a high risk for ectopic pregnancy. 5,6 More recently, characterizing the fluid as echogenic has been proposed as a significant extrauterine risk factor for ectopic pregnancy, regardless of the amount of fluid. 7 The purpose of this study was to evaluate how echogenic fluid detected by transvaginal ultrasonography correlates with surgically proven hemoperitoneum in suspected ectopic pregnancies. Echogenic fluid is an important extrauterine finding of ectopic pregnancy. The purpose of this study was to determine how accurately echogenic fluid correlates with hemoperitoneum at surgery. Transvaginal sonography was performed in 831 consecutive patients referred to rule out ectopic pregnancy over a 36 month period. Scans were retrospectively evaluated for the presence or absence and echogenicity of free pelvic fluid. Subsequently, 185 patients had a laparotomy or laparoscopy and had documentation of the presence or absence of hemoperitoneum. On transvaginal sonography 125 patients had echogenic fluid, 30 patients had anechoic fluid, and 30 patients had no fluid. Of the 125 patients with echogenic fluid, 122 (98%) patients had hemoperitoneum; none of the patients with anechoic fluid or no detected fluid had hemoperitoneum (0%). Echogenic fluid had a sensitivity of 100%, specificity of 95%, positive predictive value of 98%, and an accuracy of 98% for detecting hemoperitoneum. This study demonstrates that echogenic fluid detected by transvaginal ultrasonography accurately correlates with hemoperitoneum detected at surgery in patients with suspected ectopic pregnancy.

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“…11,19 Transvaginal ultrasonography also allows better characterization of this fluid. 7 Caution should be taken when trying to characterize fluid on transabdominal examinations.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Free echogenic pelvic fluid: correlation with hemoperitoneum.

Sickler

Chen

Dubinsky

et al. 1998

Journal of Ultrasound in Medicine

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“…The uterine cavity was searched for the presence or absence of an embryonic echo with or without a beating heart, the presence or absence of a pseudogestational sac and for the presence of double ring sign (Abramovici et al, 1983;Valenzano et al, 1991). The adnexa were explored for the presence or absence of an extra-uterine gestation sac, or a mixed adnexal mass in contact with or separate from the uterus and ovaries (Romero et al, 1988;Timor-Tritsch et al, 1989;Valenzano et al, 1991).…”

Section: Methodsmentioning

confidence: 99%

“…The adnexa were explored for the presence or absence of an extra-uterine gestation sac, or a mixed adnexal mass in contact with or separate from the uterus and ovaries (Romero et al, 1988;Timor-Tritsch et al, 1989;Valenzano et al, 1991). A fetal pole outside the uterine cavity with or without a fetal heart activity was noted.…”

Section: Methodsmentioning

confidence: 99%

Ectopic pregnancy. Diagnosis using transabdominal ultrasound and a qualitative serum hCG test. Five years' experience in the Middle East

Zaki

Bahar

1995

Journal of Obstetrics and Gynaecology

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Over 5 years a total number of 164 patients suspected of having ectopic pregnancy had transabdominal ultrasound scanning. Ninety-three of these also had a qualitative serum hCG test to find out whether using the combined diagnostic aids would reduce the need for unnecessary surgery. The sensitivity of ultrasound alone in diagnosing this condition was 90.9 per cent, the specificity was 77.1 per cent; the positive predictive value was 77.8 per cent and the negative predictive value 90.5 per cent. The sensitivity of a serum qualitative hCG test was 93.6 per cent, its specificity 100 per cent; the positive predictive value was 100 per cent and the negative predictive value 93.9 per cent. The finding of cul-de-sac fluid and an adnexal mass combined together or each alone was common in ectopic pregnancy. Ultrasound false positives do occur, and it is in these patients that qualitative hCG test confirms the pregnancy cases and reduces the need for surgery. ogy 163, 123-128. 249, 1725-1729. ogy 161, 157-161.

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Does This Woman Have an Ectopic Pregnancy?

Crochet¹,

Bastian²,

Chireau³

2013

JAMA

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ImportanceThe rapid identification and accurate diagnosis of women who may have an ectopic pregnancy is critically important for reducing the maternal morbidity and mortality associated with this condition.Objective To systematically review the accuracy and precision of the patient history, clinical examination, readily available laboratory values, and sonography in the diagnosis of ectopic pregnancy in women with abdominal pain or vaginal bleeding during early pregnancy. Data SourcesWe conducted MEDLINE and EMBASE searches for English-language articles from 1965 to December 2012 reporting on the diagnosis of ectopic pregnancy. Study SelectionThe analysis included prospective studies of 100 or more pregnant women with abdominal pain or vaginal bleeding that evaluated patient history, physical examination, laboratory values, and sonography compared with a reference standard of either (1) direct surgical visualization of ectopic pregnancy or (2) clinical follow-up for all pregnancies to prove that ectopic pregnancy was not missed. Of 10 890 articles identified by the search, 14 studies with 12 101 patients met the inclusion criteria. Data Extraction and SynthesisTwo authors ( J.R.C. and M.V.C.) independently extracted data and assessed the quality of each study. A third author (L.A.B.) resolved any discrepancies.Results All components of the patient history had a positive likelihood ratio (LRϩ) less than 1.5. The presence of an adnexal mass in the absence of an intrauterine pregnancy on transvaginal sonography (LRϩ 111; 95% CI, 12-1028; n=6885), and the physical examination findings of cervical motion tenderness (LRϩ 4.9; 95% CI, 1.7-14; n=1435), an adnexal mass (LRϩ 2.4; 95% CI, 1.6-3.7; n=1378), and adnexal tenderness (LRϩ 1.9; 95% CI, 1.0-3.5; n=1435) all increase the likelihood of ectopic pregnancy. A lack of adnexal abnormalities on transvaginal sonography (negative LR [LRϪ] 0.12; 95% CI, 0.03-0.55; n=6885) decreases the likelihood of ectopic pregnancy. Existing studies do not establish a single serum human chorionic gonadotropin (hCG) level that is diagnostic of ectopic pregnancy. Conclusions and RelevanceTransvaginal sonography is the single best diagnostic modality for evaluating women with suspected ectopic pregnancy. The presence of abdominal pain or vaginal bleeding during early pregnancy should prompt a transvaginal sonogram and quantitative serum hCG testing.

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Transabdominal and Transvaginal Ultrasonographic Diagnosis of Ectopic Pregnancy: Clinical Implications

Cited by 15 publications

References 8 publications

Free echogenic pelvic fluid: correlation with hemoperitoneum.

Free echogenic pelvic fluid: correlation with hemoperitoneum.

Ectopic pregnancy. Diagnosis using transabdominal ultrasound and a qualitative serum hCG test. Five years' experience in the Middle East

Does This Woman Have an Ectopic Pregnancy?

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