The value of adnexal sonographic findings in the diagnosis of ectopic pregnancy

Romero, Roberto; Kadar, Nicholas; Castro, Danilo; Jeanty, P; Hobbins, John C.; DeCherney, Alan H.

doi:10.1016/0002-9378(88)90774-0

Cited by 48 publications

(16 citation statements)

References 6 publications

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“…Presence of moderate or large amounts of intraperitoneal bleed should obviously raise suspicion of ectopic pregnancy. 10 The difficulty of an accurate clinical and sonographic diagnosis in symptomatic patients can, per se, justify a laparoscopy as in our cases.…”

Section: Discussionmentioning

confidence: 74%

Heterotopic Pregnancy in a Natural Conception

Baheti¹,

Jayakrishnan²

2010

International Journal of Infertility &Amp; Fetal Medicine

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Heterotopic pregnancy is rare in natural conception and most often presents as life threatening emergency like acute abdomen and hemorrhagic shock. In early unruptured stages, it presents nonspecifically, mimicking normal or abnormal pregnancy manifestations. A high index of suspicion and a definitive search for it even after confirming normal intrauterine gestation is needed. This little effort ensures a timely diagnosis and management thus preventing catastrophe. We hereby report a primigravida with unruptured heterotopic pregnancy following a natural conception, who presented as nonspecific abdominal pain. Transvaginal ultrasound was inconclusive. Emergency laparoscopy clinched the diagnosis and allowed conservative salpingostomy and continuation of intrauterine pregnancy.

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Section: Discussionmentioning

confidence: 74%

Heterotopic Pregnancy in a Natural Conception

Baheti¹,

Jayakrishnan²

2010

International Journal of Infertility &Amp; Fetal Medicine

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“…[5][6][7][8]14 Not only is the identification of fluid important but also its characterization as echogenic or anechoic. Free pelvic fluid has been shown to carry a risk for ectopic pregnancy, with echogenic fluid much more worrisome in patients referred with a clinical suspicion.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11] Intrauterine and extrauterine findings are important in both the exclusion and the diagnosis of ectopic pregnancy. Identification of an IUP, whether normal or abnormal, essentially excludes the diagnosis of ectopic pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…The identification of moderate to large amounts of fluid has been shown to correlate with a high risk for ectopic pregnancy. 5,6 More recently, characterizing the fluid as echogenic has been proposed as a significant extrauterine risk factor for ectopic pregnancy, regardless of the amount of fluid. 7 The purpose of this study was to evaluate how echogenic fluid detected by transvaginal ultrasonography correlates with surgically proven hemoperitoneum in suspected ectopic pregnancies.…”

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confidence: 99%

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Free echogenic pelvic fluid: correlation with hemoperitoneum.

Sickler

Chen

Dubinsky

et al. 1998

Journal of Ultrasound in Medicine

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ransvaginal ultrasonography has proven to be a valuable modality in evaluation of women with suspected ectopic pregnancy. [1][2][3][4] Its value lies not only in the near exclusion of ectopic pregnancy by identification of an IUP but also in the diagnosis of an ectopic pregnancy by recognition of key adnexal findings. Transvaginal ultrasonography enables the detection of extrauterine living embryos, tubal rings, complex masses, and free pelvic fluid.Pelvic fluid is an important extrauterine finding in the evaluation of a possible ectopic pregnancy. The identification of moderate to large amounts of fluid has been shown to correlate with a high risk for ectopic pregnancy. 5,6 More recently, characterizing the fluid as echogenic has been proposed as a significant extrauterine risk factor for ectopic pregnancy, regardless of the amount of fluid. 7 The purpose of this study was to evaluate how echogenic fluid detected by transvaginal ultrasonography correlates with surgically proven hemoperitoneum in suspected ectopic pregnancies. Echogenic fluid is an important extrauterine finding of ectopic pregnancy. The purpose of this study was to determine how accurately echogenic fluid correlates with hemoperitoneum at surgery. Transvaginal sonography was performed in 831 consecutive patients referred to rule out ectopic pregnancy over a 36 month period. Scans were retrospectively evaluated for the presence or absence and echogenicity of free pelvic fluid. Subsequently, 185 patients had a laparotomy or laparoscopy and had documentation of the presence or absence of hemoperitoneum. On transvaginal sonography 125 patients had echogenic fluid, 30 patients had anechoic fluid, and 30 patients had no fluid. Of the 125 patients with echogenic fluid, 122 (98%) patients had hemoperitoneum; none of the patients with anechoic fluid or no detected fluid had hemoperitoneum (0%). Echogenic fluid had a sensitivity of 100%, specificity of 95%, positive predictive value of 98%, and an accuracy of 98% for detecting hemoperitoneum. This study demonstrates that echogenic fluid detected by transvaginal ultrasonography accurately correlates with hemoperitoneum detected at surgery in patients with suspected ectopic pregnancy.

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“…u Romero and coworkers examined 220 women with beta· hCG titers less than 6000 MIU/ml and adnexal masses. 16 They concluded that the finding of a noncys· tic mass had a positive predictive value of 83%, but if fluid was present in the cul-de-sac, the predictability increased to 94% (sensitivity was only 22%). The presence of a cystic mass alone was predictive in only 35% of cases.…”

Section: -1mentioning

confidence: 99%

Ectopic pregnancy: transvaginal color Doppler of trophoblastic flow in questionable adnexa.

Kurjak¹,

Žalud²,

Schulman³

1991

Journal of Ultrasound in Medicine

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The purpose of this s tudy was to see if color flow Doppler measurements could aid in the positive diagnosis of ectopic pregnancy when no gestational sac can be seen in the adnexa. We examined 148 women with abdominal pain and suspected ectopic pregnancy by abdominal ultrasonography, followed by vaginal ultrasonography and color Doppler when the diagnosis was still uncertain. Seventy-three patients proved to have ectopic pregnancies. Color flow with low resistance and high velocity vascular signals were observed in complex adnexal masses and in some of the corpora lutea. The resistance index for ectopic trophoblast was 0.36 ± 0.02 SD. Color Doppler had both positive and negative discrimination of adnexal masses (P = 10-15 ).The resistance index for the corpora lutea was 0.48 ± 0.04. A cutoff value of 0.40 or less is proposed as a T he diagnosis of ectopic pregnancy has been improved by new technologic advances, such as beta-human chorionic gonadotropin (hCG) measurements and abdominal or vaginal sonography.•-5 Ultrasonography has been useful primarily when a gestational sac is seen in the uterus or adnexa. When no sac is visible, the diagnosis becomes one of exclusion when a pregnancy test is positive. Frequently, the clinician will request a pregnancy test and a sonogram at the same time, so the ultrasonographer must analyze the echoes of a complex adnexal mass to make diagnostic index for suspected trophoblast in the adnexa. In nine cases of ectopic pregnancy, no color flow was noted. In these women, the beta-human chorionic gonadotropin level was less than 1000 mIU/ml. The clinical operative suspicion in these cases was tubal abortion. Sensitivity and specificity were 88% and 97%, respectively, in this highly selective series. Posi· tive and negative predictive values were 97% and 89%. Color Doppler appears to be useful for the positive diagnosis of ectopic pregnancy with ultrasonography when no adnexal gestational sac is observed. Prospec· tive randomized trials will determine the ultimate clinical value of these findings.

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The value of adnexal sonographic findings in the diagnosis of ectopic pregnancy

Cited by 48 publications

References 6 publications

Heterotopic Pregnancy in a Natural Conception

Heterotopic Pregnancy in a Natural Conception

Free echogenic pelvic fluid: correlation with hemoperitoneum.

Ectopic pregnancy: transvaginal color Doppler of trophoblastic flow in questionable adnexa.

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