Ultrasound Diagnosis of Ectopic Pregnancy

 

 Buy Article Permissions and Reprints

ABSTRACT

The diagnosis of tubal ectopic pregnancy should be based upon the positive visualization of an adnexal mass using transvaginal ultrasound rather than the absence of an intrauterine gestational sac. Ultrasound diagnosis earlier in the natural history of the condition has meant that more conservative treatment options can be considered and implemented in clinically stable women. Although laparoscopy traditionally is accepted as the gold standard in the diagnosis of tubal ectopic pregnancy, there is substantial evidence that transvaginal ultrasound is the diagnostic tool of choice in modern practice. In expert hands, this single noninvasive and reproducible diagnostic test correlates well with the presence of ectopic pregnancy at the time of surgery. This article discusses the use of ultrasound as a single stand-alone test in the diagnosis of tubal ectopic pregnancy.

REFERENCES

• 1 Stovall T G, Ling F W. Single dose methotrexate: an expanded clinical trial.  Am J Obstet Gynecol. 1993;  168 1759-1765
  PubMedGoogle Scholar
• 2 Hajenius P J, Engelsbel S, Mol B W et al.. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy.  Lancet. 1997;  350 774-779
  CrossrefPubMedGoogle Scholar
• 3 Fernandez H, Yves Vincent S C, Pauthier S, Audibert F, Frydman R. Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility.  Hum Reprod. 1998;  13 3239-3243
  CrossrefPubMedGoogle Scholar
• 4 Ylostalo P, Cacciatore B, Sjoberg J, Kaariainen M, Tenhunen A, Stenman U H. Expectant management of ectopic pregnancy.  Obstet Gynecol. 1992;  80 345-348
  PubMedGoogle Scholar
• 5 Korhonen J, Stenman U H, Ylostalo P. Serum human chorionic gonadotropin dynamics during spontaneous resolution of ectopic pregnancy.  Fertil Steril. 1994;  61 632-636
  PubMedGoogle Scholar
• 6 Elson J, Tailor A, Banerjee S, Salim R, Hillaby K, Jurkovic D. Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis.  Ultrasound Obstet Gynecol. 2004;  23 552-556
  PubMedGoogle Scholar
• 7 Ankum W M, Van der Veen F, Hamerlynck J V, Lammes F B. Transvaginal sonography and human chorionic gonadotrophin measurements in suspected ectopic pregnancy: a detailed analysis of a diagnostic approach.  Hum Reprod. 1993;  8 1307-1311
  PubMedGoogle Scholar
• 8 Cacciatore B, Stenman U H, Ylostalo P. Diagnosis of ectopic pregnancy by vaginal ultrasonography in combination with a discriminatory serum hCG level of 1000 IU/L (IRP).  Br J Obstet Gynaecol. 1990;  97 904-908
  PubMedGoogle Scholar
• 9 Condous G, Okaro E, Khalid A et al.. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery.  Hum Reprod. 2005;  20 1404-1409
  CrossrefPubMedGoogle Scholar
• 10 Atri M, Valenti D A, Bret P M, Gillett P. Effect of transvaginal sonography on the use of invasive procedures for evaluating patients with a clinical diagnosis of ectopic pregnancy.  J Clin Ultrasound. 2003;  31 1-8
  CrossrefPubMedGoogle Scholar
• 11 Ankum W M, Van der Veen F, Hamerlynck J V, Lammes F B. Laparoscopy: a dispensable tool in the diagnosis of ectopic pregnancy?.  Hum Reprod. 1993;  8 1301-1306
  PubMedGoogle Scholar
• 12 Dutta R L, Economides D L. Patient acceptance of transvaginal sonography in the early pregnancy unit setting.  Ultrasound Obstet Gynecol. 2003;  22 503-507
  CrossrefPubMedGoogle Scholar
• 13 Shalev E, Yarom I, Bustan M, Weiner E, Ben-Shlomo I. Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases.  Fertil Steril. 1998;  69 62-65
  CrossrefPubMedGoogle Scholar
• 14 Brown D L, Doubilet P M. Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics.  J Ultrasound Med. 1994;  13 259-266
  CrossrefPubMedGoogle Scholar
• 15 Walters M D, Eddy C, Pauerstein C J. The contralateral corpus luteum and tubal pregnancy.  Obstet Gynecol. 1987;  70 823-826
  PubMedGoogle Scholar
• 16 Jurkovic D, Bourne T H, Jauniaux E, Campbell S, Collins W P. Transvaginal color Doppler study of blood flow in ectopic pregnancies.  Fertil Steril. 1992;  57 68-73
  PubMedGoogle Scholar
• 17 DiMarchi J M, Kosasa T S, Hale R W. What is the significance of the human chorionic gonadotropin value in ectopic pregnancy?.  Obstet Gynecol. 1989;  74 851-855
  PubMedGoogle Scholar
• 18 Saxon D, Falcone T, Mascha E J, Marino T, Yao M, Tulandi T. A study of ruptured tubal ectopic pregnancy.  Obstet Gynecol. 1997;  90 46-49
  CrossrefPubMedGoogle Scholar
• 19 Condous G, Okaro E, Bourne T. The conservative management of early pregnancy complications: a review of the literature.  Ultrasound Obstet Gynecol. 2003;  22 420-430
  PubMedGoogle Scholar
• 20 Condous G. The management of early pregnancy complications.  Best Pract Res Clin Obstet Gynaecol. 2004;  18 37-57
  CrossrefPubMedGoogle Scholar
• 21 Condous G, Okaro E, Khalid A et al.. The use of a new logistic regression model for predicting the outcome of pregnancies of unknown location.  Hum Reprod. 2004;  19 1900-1910
  CrossrefPubMedGoogle Scholar
• 22 Condous G, Okaro E, Khalid A et al.. A prospective evaluation of a single-visit strategy to manage pregnancies of unknown location.  Hum Reprod. 2005;  20 1398-1403
  CrossrefPubMedGoogle Scholar
• 23 Condous G, Okaro E, Bourne T. Pregnancies of unknown location: diagnosis dilemmas and their management.  Curr Opin Obstet Gynecol. 2005;  17 568-573
  PubMedGoogle Scholar
• 24 Condous G, Kirk E, Van Calster B, Van Huffel S, Timmerman D, Bourne T. Failing pregnancies of unknown location: a prospective evaluation of the human chorionic gonadotrophin ratio.  Br J Obstet Gynaecol. 2006;  113 521-527
  PubMedGoogle Scholar
• 25 Condous G, Jurkovic D, Timmerman D, Goldstein S, Valentin L, Bourne T. Pregnancies of unknown location: consensus statement.  Ultrasound Obstet Gynecol. 2006;  28 121-122
  PubMedGoogle Scholar

George S CondousM.B.B.S. 

Early Pregnancy and Advanced Endosurgery Unit, Nepean Clinical School, University of Sydney

Nepean Hospital, Sydney, Australia

Email: gcondous@hotmail.com