Diagnosis of ectopic pregnancy: endovaginal vs transabdominal sonography.

Thorsen, M K; Lawson, Ted; Aiman, E.James; Miller, D P; McAsey, Mary E.; Erickson, S J; Quiroz, Francisco; Perret, R S

doi:10.2214/ajr.155.2.2115257

Cited by 50 publications

(22 citation statements)

References 8 publications

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“…[8][9][10][11] Ankum et al, 12 using an algorithm similar to ours, 7 combining TVS and a discriminatory level of ␤-hCG, reported a sensitivity of 97%, a specificity of 95%, a likelihood ratio for a positive result of 19.4, and a likelihood ratio for a negative result of 0.03 in diagnosing EP. They concluded that this diagnostic strategy proved extremely reliable in the safe care of patients at risk for EP and rendered the use of laparoscopy obsolete.…”

Section: Discussionmentioning

confidence: 99%

Effect of transvaginal sonography on the use of invasive procedures for evaluating patients with a clinical diagnosis of ectopic pregnancy

Atri

Valenti

Bret

et al. 2002

J of Clinical Ultrasound

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Section: Discussionmentioning

confidence: 99%

Effect of transvaginal sonography on the use of invasive procedures for evaluating patients with a clinical diagnosis of ectopic pregnancy

Atri

Valenti

Bret

et al. 2002

J of Clinical Ultrasound

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“…Of these, 20 were excluded because a final diagnosis could not be definitively determined. Out of the 20 excluded patients, 8 had empty endometrial cavities, none had echogenic material, 6 had nonspecific fluid, 3 had abnormal sacs, and 3 had normal sacs.…”

Section: Resultsmentioning

confidence: 99%

Subclassification of Indeterminate Pelvic Ultrasonograms: Stratifying the Risk of Ectopic Pregnancy

Dart

Howard

1998

Academic Emergency Medicine

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Objective: To determine whether the subclassification of indeterminate ultrasound readings can identify patients who are at high, intermediate, or low risk for ectopic pregnancy. Methods: A retrospective review was made of consecutive ED patients presenting to an urban teaching hospital from August 1991 to December 1994 with abdominal pain and/or vaginal bleeding and a positive β‐hCG. Patients who had transvaginal ultrasonograms obtained during the ED visit that were read as indeterminate (no extrauterine findings of ectopic pregnancy and no intrauterine fetal pole or yolk sac) were eligible. Ultrasonograms were subclassified into 5 groups (empty uterus, nonspecific intrauterine fluid, echo‐genic debris within endometrial cavity, abnormal sac, normal sac) based on predetermined criteria. Patients were excluded if the final diagnosis could not be definitively determined. Results: 248 patients were identified. 20 patients were excluded because a final diagnosis could not be determined. Patients with an empty uterus [25/94 = 27% (95% CI 18–36%)] had the highest frequency of ectopic pregnancy. Patients with nonspecific intrauterine fluid collections [4/30 = 13% (95% CI 4–31%)] had the next highest frequency of ectopic pregnancy. Patients with intrauterine echogenic debris [2/39 = 5% (95% CI 1–11%)], abnormal sacs [1/36 = 3% (95% CI 1–9%)], or normal‐appearing sacs [0/29 = 0% (95% CI 0 ‐8%)] had low frequencies of ectopic pregnancy. Conclusion: Subclassification of indeterminate ultrasound readings identifies patients at high, intermediate, or low risk for ectopic pregnancy and should improve the diagnostic accuracy of ultrasonography in patients at risk for ectopic pregnancy. Key words: ectopic pregnancy; tubal pregnancy; intrauterine pregnancy; ultrasound; diagnosis.

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“…[26][27][28][29] Cul-de-sac fluid also is well visualized by vaginal sonography. Free fluid is seen in 24-63% of women with ectopic p r e g n a n c i e~.…”

Section: Sonographymentioning

confidence: 93%

Ectopic Pregnancy—Part II: Diagnostic Procedures and Imaging

Brennan¹

1995

Academic Emergency Medicine

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SUMMARYEctopic pregnancy is an increasingly common and potentially catastrophic condition in which the patient often presents to the ED with abdominal pain or vaginal bleeding. Recent developments in the laboratory (sensitive PhCG assays, progesterone assays), in ultrasonogra‐phy (transvaginal probes, Doppler ultrasonography), and in the combination of modalities (discriminatory zone of PhCG for ultrasono‐graphic evidence of IUP) have allowed the earlier diagnosis of ectopic pregnancy, with the potential for a reduction in maternal mortality and morbidity.Understanding the strengths and limitations of the variety of diagnostic modalities available will allow the clinician to formulate a rational strategy for the early diagnosis of ectopic pregnancy. Numerous algorithms have been developed. All begin wiht high clinical suspicion for women of reproductive age with abdominal/ pelvic pain or vaginal bleeding. Pregnancy testing with a sensitive PhCG qualitative test is next. For stable patients found to be pregnant, zoography generally follows (often first Tran abdominally then transvaginally). Unstable patients require immediate resuscitation and gynecology consultation; invasive diagnostic methods may supplant laboratory studies and sonography. Unclear cases may necessitate the use of quantitative PhCG (discriminatory zone), other pregnancy hormones (progesterone), invasive procedures (laparoscopy, culdocentesis, D&C), or observation (serial ßhCGs). A suggested algorithm incorporating these elements is shown (Fig. 1).

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Diagnosis of ectopic pregnancy: endovaginal vs transabdominal sonography.

Cited by 50 publications

References 8 publications

Effect of transvaginal sonography on the use of invasive procedures for evaluating patients with a clinical diagnosis of ectopic pregnancy

Effect of transvaginal sonography on the use of invasive procedures for evaluating patients with a clinical diagnosis of ectopic pregnancy

Subclassification of Indeterminate Pelvic Ultrasonograms: Stratifying the Risk of Ectopic Pregnancy

Ectopic Pregnancy—Part II: Diagnostic Procedures and Imaging

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