Hum. Reprod. Advance Access originally published online on February 3, 2005
Human Reproduction 2005 20(5):1404-1409; doi:10.1093/humrep/deh770
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery
1 Early Pregnancy, Gynaecological Ultrasound and Minimal Access Surgery Unit, St George's Hospital Medical School, London, UK 2 Department of Electrical Engineering (ESAT), and 3 Department of Obstetrics and Gynaecology, University Hospital, Gasthuisberg, K.U. Leuven, Belgium
4 To whom correspondence should be addressed at: Early Pregnancy, Gynaecological Ultrasound and MAS Unit, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. Email: gcondous{at}hotmail.com
BACKGROUND: To evaluate the accuracy of transvaginal ultrasonography (TVS) for the detection of ectopic pregnancies (EPs) in women undergoing surgery for presumed ectopic pregnancy. METHODS: A prospective, observational study. Women were diagnosed with an EP using TVS if any of the following were noted in the adnexal region: (i) an inhomogeneous mass or blob sign adjacent to the ovary and moving separately from the ovary; or (ii) a mass with a hyper-echoic ring around the gestational sac or bagel sign; or (iii) a gestational sac with a fetal pole with or without cardiac activity. The final diagnosis was based on the findings at surgery and subsequent histology of removed tissues. RESULTS: 6621 consecutive women underwent TVS during the study; 200/6621 (3.0%) women were diagnosed as having an EP using TVS. Forty-eight non-surgically managed women were excluded from the analysis. 85.5% of women presented with symptoms and 14.5% were asymptomatic. In 88 (57.9%) cases an inhomogeneous mass or blob sign was visualized and in 20 cases (13.2%) an embryo±cardiac activity. Thirty-one (20.4%) had a hyper-echoic ring in the adnexa. In 11 (7.2%) cases there was no evidence of either an intra-uterine (IUP) or EP on ultrasound. Two (1.3%) IUPs were subsequently diagnosed as heterotopic pregnancies. There was no association between the presenting complaints and TVS findings. 152 surgical procedures were performed. In 5.9% (9/152) of these cases no EPs were confirmed in fallopian tube or pelvis at laparoscopy. In 9.1% (13/143) of cases an EP was visualized at surgery when not seen on the index ultrasound scan. The sensitivity and specificity of TVS to detect EP were 90.9% and 99.9%, respectively, with positive and negative predictive values of 93.5% and 99.8%, respectively. CONCLUSIONS: 90.9% of ectopic pregnancies in this study population can be accurately diagnosed using TVS prior to surgery. The diagnosis of an ectopic pregnancy should be based on the positive visualization of an adnexal mass using TVS. This should in turn result in a decrease in the number of false positive laparoscopies.
Key words: ectopic pregnancy/adnexal mass/inhomogeneous mass (blob sign)/hyper-echoic ring/transvaginal ultrasonography
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  C. Bottomley, V. Van Belle, F. Mukri, E. Kirk, S. Van Huffel, D. Timmerman, and T. Bourne The optimal timing of an ultrasound scan to assess the location and viability of an early pregnancy Hum. Reprod., August 1, 2009; 24(8): 1811 - 1817. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. T. Barnhart Ectopic Pregnancy N. Engl. J. Med., July 23, 2009; 361(4): 379 - 387. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Sagili and K. Mohamed Pregnancy of unknown location: an evidence-based approach to management Obstet Gynaecol (Lond), October 1, 2008; 10(4): 224 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Kirk, A. T. Papageorghiou, G. Condous, L. Tan, S. Bora, and T. Bourne The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy Hum. Reprod., November 1, 2007; 22(11): 2824 - 2828. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Kirk, G. Condous, B. Van Calster, S. Van Huffel, D. Timmerman, and T. Bourne Rationalizing the follow-up of pregnancies of unknown location Hum. Reprod., June 1, 2007; 22(6): 1744 - 1750. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Condous, B. Van Calster, E. Kirk, D. Timmerman, S. Van Huffel, and T. Bourne Prospective cross-validation of three methods of predicting failing pregnancies of unknown location Hum. Reprod., April 1, 2007; 22(4): 1156 - 1160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Condous, E. Kirk, C. Lu, B. Van Calster, S. Van Huffel, D. Timmerman, and T. Bourne There is no role for uterine curettage in the contemporary diagnostic workup of women with a pregnancy of unknown location Hum. Reprod., October 1, 2006; 21(10): 2706 - 2710. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F.R. Cabar, P.P. Pereira, R. Schultz, and M. Zugaib Predictive factors of trophoblastic invasion into the ampullary region of the tubal wall in ectopic pregnancy Hum. Reprod., September 1, 2006; 21(9): 2426 - 2431. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Gevaert, F. De Smet, E. Kirk, B. Van Calster, T. Bourne, S. Van Huffel, Y. Moreau, D. Timmerman, B. De Moor, and G. Condous Predicting the outcome of pregnancies of unknown location: Bayesian networks with expert prior information compared to logistic regression Hum. Reprod., July 1, 2006; 21(7): 1824 - 1831. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Condous, E. Kirk, A. Syed, B. Van Calster, S. Van Huffel, D. Timmerman, and T. Bourne Do levels of serum cancer antigen 125 and creatine kinase predict the outcome in pregnancies of unknown location? Hum. Reprod., December 1, 2005; 20(12): 3348 - 3354. [Abstract] [Full Text] [PDF]
|
|