Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice

Abstract

STUDY QUESTION What recommendations can be provided to improve terminology for normal and ectopic pregnancy description on ultrasound? SUMMARY ANSWER The present ESHRE document provides 17 consensus recommendations on how to describe normally sited and different types of ectopic pregnancies on ultrasound. WHAT IS KNOWN ALREADY Current diagnostic criteria stipulate that each type of ectopic pregnancy can be defined by clear anatomical landmarks which facilitates reaching a correct diagnosis. However, a clear definition of normally sited pregnancies and a comprehensive classification of ectopic pregnancies are still lacking. STUDY DESIGN, SIZE, DURATION A working group of members of the ESHRE Special Interest Group in Implantation and Early Pregnancy (SIG-IEP) and selected experts in ultrasound was formed in order to write recommendations on the classification of ectopic pregnancies. PARTICIPANTS/MATERIALS, SETTING, METHODS The working group included nine members of different nationalities with internationally recognised experience in ultrasound and diagnosis of ectopic pregnancies on ultrasound. This document is developed according to the manual for development of ESHRE recommendations for good practice. The recommendations were discussed until consensus by the working group, supported by a survey among the members of the ESHRE SIG-IEP. MAIN RESULTS AND THE ROLE OF CHANCE A clear definition of normally sited pregnancy on ultrasound scan is important to avoid misdiagnosis of uterine ectopic pregnancies. A comprehensive classification of ectopic pregnancy must include definitions and descriptions of each type of ectopic pregnancy. Only a classification which provides descriptions and diagnostic criteria for all possible locations of ectopic pregnancy would be fit for use in routine clinical practice. The working group formulated 17 recommendations on the diagnosis of the different types of ectopic pregnancies on ultrasound. In addition, for each of the types of ectopic pregnancy, a schematic representation and examples on 2D and 3D ultrasound are provided. LIMITATIONS, REASONS FOR CAUTION Owing to the limited evidence available, recommendations are mostly based on clinical and technical expertise. WIDER IMPLICATIONS OF THE FINDINGS This document is expected to have a significant impact on clinical practice in ultrasound for early pregnancy. The development of this terminology will help to reduce the risk of misdiagnosis and inappropriate treatment. STUDY FUNDING/COMPETING INTEREST(S) The meetings of the working group were funded by ESHRE. T.T. declares speakers’ fees from GE Healthcare. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A DISCLAIMER This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. ESHRE’s GPRs should be used for informational and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. Furthermore, ESHRE’s GPRs do not constitute or imply the endorsement, recommendation or favouring of any of the included technologies by ESHRE.

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies

“…Interstitial pregnancies were classified as tubal pregnancies, as per ESHRE definition. Pregnancies growing in a non-communicating rudimentary horn of a unicornuate uterus were also classified as ectopics ( ESHRE working group on Ectopic Pregnancy, 2020 ).…”

“…A heterotopic pregnancy (HP) is defined as the simultaneous occurrence of a normally sited (eutopic) pregnancy and an ectopic pregnancy ( ESHRE working group on Ectopic Pregnancy, 2020 ). The presence of a normally sited pregnancy is often perceived as a reassuring sign by clinicians when assessing women presenting with clinical signs suspicious of ectopic pregnancy.…”

Using MRI to differentiate upper-lateral intracavitary pregnancy and interstitial pregnancy for the patients with pregnancies in the uterotubal junction during the first trimester

“…Upper-lateral intracavitary pregnancy [ 1 ], previously named angular pregnancy [ 2 – 4 ], is a type of potentially viable, eccentric, intracavitary pregnancy located in the cornua of the normal uterus [ 5 , 6 ]. While deliberate termination of upper-lateral intracavitary pregnancy could avoid the risk of uterine rupture, expectant management is an alternative [ 4 , 7 ].…”

Surgical Treatment Following Failed Medical Treatment of an Interstitial Pregnancy

“…Interstitial pregnancy (IP) is a rare condition representing about 2–6% of all ectopic pregnancies [ 1 ]. It occurs when the gestational sac implants into the interstitial portion of the Fallopian tube, where it penetrates the myometrium [ 2 , 3 ]. Maternal mortality rate related to IP is around 2–2.5% [ 4 ].…”