Sonographic Evaluation of Clinical Suspicion for Ectopic Pregnancy

Abstract

Abstracts Analysis of transabdominal ultrasonic findings of 167 patients presented with clinical suspicion of extrauterine pregnancies (EUP), all with measurable serum HCG, has been undertaken. Patients were divided into two main groups, namely those with demonstrable typical intrauterine gestational sac (46.7%), and those without (53.3%). This later group of patients, i.e., without intrauterine sac, was further subdivided into four other groups depending on whether or not they have adnexal mass and/or fluid in cul‐de‐sac. In this first subgroup of patients (21 cases), without any demonstrable mass or fluid, a positive predictive value (PPV) for EUP of only 28.6% was obtained. With ultrasound showing fluid but no mass, the PPV was 55.6%, while those with both mass and fluid, the PPV as high as 95.7% was possible. Characterization of the adnexal mass or cul‐de‐sac findings among those with empty uterus may further improve PPV. The results of this study indicates that ultrasonic examination can help to provide a more correct diagnosis in the investigation of EUP. EUP can be easily excluded, in the great majority of cases, with sonographic visualization of intrauterine pregnancy. In the case of empty uterus with no mass nor fluid, patients should be closely followed up with HCG titer and ultrasonic examination. For those with empty uterus with fluid, culdocentesis may be indicated; whereas in the case of empty uterus with mass, laparoscopy should be considered as additional investigative procedures.

Accuracy of first‐trimester ultrasound in diagnosis of tubal ectopic pregnancy in the absence of an obvious extrauterine embryo: systematic review and meta‐analysis

“…Following review of the titles and abstracts, 294 full‐text papers were selected for further examination and subsequently 263 of these studies were excluded (Figure ). Thirty‐one studies, including 5858 women, met the inclusion criteria and were incorporated into the systematic review. The characteristics of the included studies are shown in Table S1.…”

“…Twenty‐one cohort studies, including 2787 women in early pregnancy, evaluated the diagnostic accuracy of an adnexal mass for predicting the likelihood of an ectopic pregnancy; Figure shows its sensitivity and specificity in the individual studies. The precision estimates for each of the studies and estimated sensitivity and specificity for differentiating between an ectopic and an intrauterine pregnancy are shown in Figure c and Table .…”

“…Eight studies were retrospective in nature, 10 were small (including fewer than 100 participants) and 22 were undertaken more than 20 years ago. Many studies did not describe fully the methods of patient selection, hence it is unclear whether the selection of patients could have introduced bias. One study included only women who underwent surgery for suspected ectopic pregnancy and three studies included women who were at particularly high risk of ectopic pregnancy as they had risk factors for, as well as symptoms suggestive of, ectopic pregnancy.…”

“…Eleven studies did not define clearly the reference standard and in the majority of studies it was unclear whether the results of the reference standard were interpreted without knowledge of the index test. One study clearly stated that the results of the ultrasound were known at the time of surgery and were often an important factor in the decision‐making process, which could have introduced bias.…”

“…This is most probably a reflection of the different inclusion criteria of the studies; for example, one study included only women who underwent a diagnostic laparoscopy for suspicion of an ectopic pregnancy. Clearly the prevalence of an ectopic pregnancy in this study will be higher than in those that included only women with a positive urinary pregnancy test or in those that included women with symptoms of abdominal pain and/or vaginal bleeding. Studies that included women with risk factors for ectopic pregnancy and those that included symptomatic pregnant women with indeterminate ultrasound scans are also likely to have a different prevalence of ectopic pregnancy.…”