This case demonstrates the importance of including idiopathic ovarian vein thrombosis in the differential diagnosis of nonperipartum females with pelvic pain.

This case series describes changes in size, vascularity, and cul-de-sac fluid in 30 patients with ectopic pregnancies who were treated with systemic methotrexate. Pretreatment and posttreatment transvaginal sonography of the ectopic pregnancies was performed with color Doppler imaging, and the images were assessed for changes in size, vascularity, and cul-de-sac free fluid. There was a trend for nonresponders to show increased vascularity on serial examinations, although this finding was also seen in a single responder. There was also a trend for nonresponders with increased vascularity to be associated with a greater increase in β-human chorionic gonadotropin levels and responders with decreased vascularity to be associated with a greater decrease in β-human chorionic gonadotropin levels.

Objectives: To assess if Doppler ultrasound improves the diagnostic accuracy of histologically confirmed RPOC. Examination of inter observer variability in diagnosis and measurement of RPOC. Methods: Retrospective analysis of and image review from ultrasound database of diagnoses of incomplete miscarriage in a tertiary referral early pregnancy unit from January to December 2014. Histological concordance was sought for those undergoing surgical management. Scan images were reviewed by two independent sonographers for accuracy of measurements and vascularity, including correct Doppler settings. Reviewers were blinded to the histological report. Results: A scan diagnosis of incomplete miscarriage was made in 699 cases of whom 117 underwent surgical management. A second procedure and repeat scan was required in 4 patients. 121 scans were reviewed. Histology confirmed RPOC in 115/121 (95%). Reviewer A disagreed with 45/121 (37%) and reviewer B 17/121 (14%) of measurements. In 8/121 (7%) of the same cases both reviewers disagreed with the original measurements. Measurements were overestimated. Power or colour Doppler was used in 96/121 (79%) cases. Reviewer A agreed with the operator's assessment of vascularity in 92/96 (96%) and reviewer B in 64/96 (66%) of scans. Vascular uptake subsequently assessed to be in the myometrium was the most common reason for disagreement. The original report concluded 15/96 (15%) of cases were avascular. Histology confirmed trophoblast in 13/15 (96%) of these. Conclusions:The diagnosis of RPOC remains subjective leading to unnecessary follow up and increased intervention rates with associated social disruption and management related complications for the patient. This dataset is being expanded to review images of all incomplete miscarriages, operation findings and histological measurements. Objectives: To assess the transvaginal sonography (TVS) findings of systemically treated ectopic pregnancies and to correlate these findings to changes in βhCG and clinical response. Methods: A retrospective analysis was performed of 30 women with ectopic pregnancies treated with systemic methotrexate (MTX) with pre-and post-treatment TVS. Patients were considered responsive to treatment if βhCG levels decreased by 15% of baseline 4-7 days following a single dose MTX. Patients were considered non-responsive if βhCG levels increased, or if a second dose of MTX or surgical intervention was required. Pre-and post-treatment images were evaluated for changes in ectopic size (increase defined as greater than 15% volume increase), vascularity and cul-de-sac fluid. OC19.04 Sonography of responsive versus non-responsive ectopic pregnanciesResults: Of the 7 responders and 23 non-responders, ectopic size increased in 57% of responders and 61% of non-responders. There was an increase in vascularity in 14% of responders compared to 39% of non-responders and a decrease in vascularity in 43% of responders compared to 35% of non-responders. Of the non-responders, increased vascularity was associated with a greater a...

No abstract