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

PURPOSE: Our purpose was to determine the effect of transvaginal sonography (TVS) on the diagnostic evaluation of patients with suspected ectopic pregnancy (EP). Specifically, we wished to determine what effect TVS had on the use of invasive procedures. METHODS: This was a retrospective review of the medical records of 290 patients with a surgically documented diagnosis of EP. It included 147 consecutive patients from the era of use of suprapubic sonography (SPS) (1982-1987) and 143 consecutive patients from the era of use of TVS (1987-1995). We compared the percentages of patients who had undergone sonographic examinations, the rates of use of the invasive procedures dilatation and curettage (D&C) and diagnostic laparoscopy (DL), time from presentation to diagnosis, necessity for transfusion, status of EP at surgery, and various other characteristics of the patients (eg, demographics, serum level of beta human chorionic gonadotropin, and presenting symptoms). RESULTS: In the SPS era, 46.9% of the patients had undergone sonography, compared with 78.3% in the TVS era (p = 0.001). Sonographic sensitivity was 60.9% in the SPS era and 93.8% in the TVS era (p = 0.001). D&C was performed in 53.1% and DL in 76.2% of patients in the SPS era, compared with 14.0% and 30.8%, respectively, in the TVS era (p = 0.001). In the last full year of the study, only 9% of the patients had undergone D&C and 9%, DL. The overall time from presentation to diagnosis significantly decreased from 45.6 hours in the SPS era to 16.8 hours in the TVS era (p = 0.002). We found no significant difference between the 2 eras in the need for transfusion and the percentage of ruptured EPs at surgery (p > 0.05). CONCLUSIONS: The introduction of TVS has had an important effect on the evaluation of patients with EP by nearly eliminating the need for D&C and DL and permitting clinicians to take a more conservative approach to managing EP.