经阴道彩色多普勒超声诊断异位妊娠的临床价值

目的 探讨经阴道彩色多普勒超声诊断异位妊娠的价值。方法 选取72例疑似异位妊娠患者为研究对象,术前均接受经阴道彩色多普勒超声与经腹部彩色多普勒超声检查,以手术病理结果为诊断标准,比较两种检查方式的诊断效能及异位妊娠典型声像图特征检出情况。结果 72例疑似异位妊娠患者经手术病理确诊61例,余下9例为其余腹部急症。经阴道彩色多普勒超声检查的诊断准确率、灵敏度、特异度、阳性预测值与阴性预测值为95.83%、96.72%、90.91%、98.33%、83.33%,高于经腹部彩色多普勒超声检查的73.61%、83.61%、18.18%、85.00%、16.67%(P<0.05)。经阴道彩色多普勒超声检查对混合型团块、疑似孕囊影、胚芽胎心、盆腔积液征象检出率分别为80.56%、61.11%、52.78%、88.89%,均明显高于经腹部彩色多普勒超声检查的58.33%、22.22%、30.56%、62.50%(P<0.05)。结论 经阴道彩色多普勒超声检查诊断异位妊娠的诊断效能较经腹部彩色多普勒超声检查更高,且异位妊娠典型声像图特征检出率更高,值得推广。     

经阴道与经腹部彩色多普勒超声诊断早期异位妊娠的价值

目的分析经阴道与经腹部彩色多普勒超声诊断早期异位妊娠的价值。方法选取2014年5月~2015年7月我院收治的早期异位妊娠患者120例作为研究对象,将其随机分为观察组和对照组,各60例,对照组采用经腹部彩色多普勒超声进行诊断,观察组采用经阴道彩色多普勒超声进行诊断,对比两组患者的诊断效果。结果对照组诊断出异位妊娠38例(63.33%),观察组诊断出异位妊娠55例(91.66%),观察组诊断效果明显优于对照组,差异有统计学意义(P0.05)。结论通过经阴道和经腹部彩色多普勒超声诊断比较,经阴道彩色多普勒超声的检测率、准确率高,诊断时间早。进行早期异位妊娠诊断时,应首选经阴道彩色多普勒超声,值得临床推广与使用。     

彩色多普勒超声对异位妊娠的诊断价值

目的:探讨彩色多普勒超声对异位妊娠的诊断价值.方法:对临床确诊的异位妊娠患者应用经腹部彩色多普勒超声和经阴道彩色多普勒超声检查,比较两种检查技术的诊断符合率。结果:经阴道彩色多普勒超声的诊断符合率(75.6%)明显高于应用经腹部彩色多普勒超声(24.4%)。结论:经阴道彩色多普勒超声具有高分辨率特征,使异位妊娠的诊断率得以提高,在临床中具有较高的应用价值。     

经阴道彩色多普勒超声诊断卵巢妊娠的临床价值

目的探讨经阴道彩色多普勒超声对卵巢妊娠的诊断价值.方法对40例经病理证实的卵巢妊娠的术前经阴道彩色多普勒超声检测结果作回顾性分析.结果卵巢内胚囊型13例,卵巢表面不均质型16例,输卵管部位杂乱低回声型¨例.其中经阴道超声检查确诊29例(73%),误诊11例(27%),9例误诊为输卵管妊娠,2例误诊为妊娠黄体.结论经阴道彩色多普勒超声对诊断卵巢妊娠具有重要作用.     

经阴道彩色多普勒超声检查对诊断剖宫产子宫瘢痕妊娠的临床意义

目的 探讨经阴道彩色多普勒超声检查对诊断剖宫产子宫瘢痕妊娠的临床意义。方法 选取50例剖宫产子宫瘢痕妊娠患者,分别实施经阴道彩色多普勒超声检查和经腹部彩色多普勒超声检查。对比两种检查方法患者的误诊率、漏诊率、确诊率、超声声像分型及满意度。结果 经阴道彩色多普勒超声的确诊率为98.00%,高于经腹部彩色多普勒超声诊断的82.00%,经阴道彩色多普勒超声诊断的误诊率低于经腹部彩色多普勒超声（P<0.05）。两种诊断方法显示的超声声像分型比较,差异无统计学意义（P>0.05）。经阴道彩色多普勒超声诊断的满意度明显高于经腹部彩色多普勒超声（P<0.05）。结论 采用经阴道彩色多普勒超声诊断剖宫产子宫瘢痕妊娠,具有较高的诊断确诊率,且能清晰显示声像分型,获得患者的认可与满意。     

经阴道彩色多普勒超声诊断异位妊娠的临床价值

目的通过对异位妊娠二维声像图及彩色多普勒血流特征的分析，提高对异位妊娠诊断和鉴别诊断的水平。方法对手术病理证实的72例异位妊娠患者附件包块的二维图像和血流频谱特征进行回顾性分析。结果异位妊娠包块中的血流显像有特征性表现：血流阻力指数〈0．4。72例中38例为非典型异位妊娠，二维超声诊断符合率为50．2％，结合彩色多普勒技术诊断符合率为98．8％。结论经阴道彩色多普勒超声检查，对异位妊娠诊断的准确性高，在诊断非典型异位妊娠方面有较高的使用价值。     

腹部超声与阴道超声在诊断早期妊娠的应用比较

目的：探讨和分析在诊断早期妊娠患者中采用阴道超声与腹部超声的临床应用价值。方法：对我院收治的50例早期妊娠患者同时经腹及经阴道彩色超声检查,观察检查结果。结果：同一时期经腹超声确诊宫内早孕43例,附件区包块1例,宫内妊娠6例,经阴道超声确诊早孕46例,宫内妊娠提示孕卵枯萎2例,附件区包块2例,对照后发现,经腹超声符合率86％,经阴道超声符合率92％,经腹误诊3例。漏诊1例。结论：在临床上,对早期妊娠患者采用阴道超声检查,具有更高的诊断准确率,为临床诊断和治疗提供了有力的依据,值得在临床上进行推广和应用。     

不同途径彩色多普勒超声诊断剖宫产瘢痕妊娠44例比较分析

目的:探讨3种不同途径的彩色多普勒超声诊断方法对剖宫产瘢痕妊娠(CSP)诊断的准确性。方法:选择2009年1月至2013年12月,泰山医学院附属医院以及泰安市中心医院共收治经临床以及术后病理证实的CSP患者44例,根据彩色多普勒超声的不同途径分为经腹组(13例)、经阴道组(17例)、经腹联合经阴道组(14例),比较3组的诊断准确率和误诊率,以及误诊导致的误治情况。结果:1经腹组诊断准确8例(61.5%),误诊5例(38.5%);经阴道组诊断准确13例(76.5%),误诊4例(23.5%),经腹联合经阴道组诊断准确13例(92.9%),误诊1例(7.1%)。210例误诊患者中,经腹组误诊为稽留流产的3例患者以及经阴道组误诊为稽留流产的1例患者口服戊酸雌二醇后行负压吸引术时发生大出血,其中3例术后给予纱条填塞宫腔压迫方止血,另1例因出血难以控制中转开腹行局部病灶切除术加子宫修补术。经腹组误诊为宫颈妊娠的2例患者,经阴道组误诊为宫颈妊娠的3例患者以及经腹部联合阴道组误诊为宫颈妊娠的1例患者均行子宫动脉栓塞术并动脉内注射甲氨蝶呤,然后行负压吸引术,方治疗成功。结论:经腹联合经阴道彩色多普勒超声检查较经腹及经阴道彩色多普勒超声检查的诊断准确率高,而误诊率最低,推荐临床上选择经腹联合经阴道彩色多普勒超声检查作为诊断CSP检查方法。     

剖宫产后切口妊娠的临床诊治分析

目的:研究剖宫产后子宫切口妊娠的临床表现及治疗方法等特征,为临床医生早期诊断、早期处理本病提供依据。方法:对25例患者的病史、临床表现、诊断方法以及治疗方法进行回顾性分析。结果:25例患者中有23例经阴道超声检查或彩色多普勒超声检查确诊;本病初诊误诊19例,误诊率76%,25例患者中保守治疗22例,21例痊愈,占95.45%;2例治疗失败而行全子宫切除术。结论:有剖宫产史的妇女因停经就诊时,要常规行阴道超声检查,对阴道超声怀疑切口妊娠的病例,有必要行彩色多普勒超声检查;彩色多普勒超声检查可作为诊断切口妊娠的主要方法;甲氨蝶呤加清宫术可作为治疗切口妊娠的主要方法,可有效地避免子宫切除。     

经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠的临床价值

目的探讨经阴道彩色多普勒超声诊断剖宫产切口瘢痕妊娠(CSP)的临床价值。方法收集2012年10月至2014年10月沈阳市妇婴医院收治的64例经阴道超声诊断为剖宫产切口瘢痕妊娠患者的影像及临床资料,分析其超声声像图特征及与临床结局的关系。结果超声诊断为CSP的64例患者中59例(92.2%)经病理证实,5例为难免流产。根据超声声像图特征将59例CSP分为2型:孕囊型(41例)和混合回声型(18例)。孕囊型分为3个亚型:I型妊娠囊边缘位于切口处(24例),Ⅱ型妊娠囊陷入切口内(15例),Ⅲ型妊娠囊向膀胱方向凸出(2例)。I型治疗以宫腔镜为主,Ⅱ型、Ⅲ型及混合回声型治疗以腹腔镜为主。结论经阴道彩色多普勒超声为诊断CSP的有效方法,正确的超声分型及对切口瘢痕厚度的准确测量有助于临床医生选择更加适合患者的个体化治疗方案。     

Use of three-dimensional ultrasound in evaluating the intrauterine position of a levonorgestrel-releasing intrauterine system

This paper reports the first case of three-dimensional (3-D) transvaginal ultrasonography (TVS) imaging of malpositioned levonorgestrel-releasing intrauterine system (LNG-IUS). In patients carrying LNG-IUS, the application of 3-D TVS with the adjunctive volume contrast imaging in the coronal plane (VCI-C) and inversion rendering modes clearly display the correct spatial position of the LNG-IUS in relation to the uterine cavity much better than two-dimensional ultrasound.     

Early detection of ectopic pregnancy. Use of a sensitive urine pregnancy test and transvaginal ultrasonography

We performed a prospective study to evaluate the reliability of a rapid monoclonal antibody urine pregnancy test with a sensitivity limit of 20 mIU/mL combined with transvaginal ultrasonography in the early diagnosis of ectopic pregnancy in 116 women with subacute pelvic pain and a stable general condition. The diagnosis of tubal pregnancy was confirmed with laparoscopy in 100 of the 103 women with positive sensitive urine pregnancy tests and no intrauterine gestational sac at transvaginal ultrasonography. Laparoscopy revealed a hemorrhagic corpus luteum in four of the eight subjects with negative monoclonal antibody pregnancy tests and no intrauterine gestational sac, an ovarian cyst in three and a normal pelvis in one. Of the five women with a positive pregnancy test and an intrauterine gestational sac, two had a hemorrhagic corpus luteum, two a normal pelvis and one a tubal pregnancy at laparoscopy. The sensitivity of a monoclonal antibody urine pregnancy test and transvaginal ultrasonography combined for the diagnosis of ectopic pregnancy was 99%, and the specificity was 80%, with positive and negative predictive values of 97% and 92%, respectively.     

Primary application of three-dimensional ultrasonography to early diagnosis of ectopic pregnancy

Preliminary evaluation of three-dimensional (3D) imaging for early diagnosis of ectopic pregnancy. Twelve asymptomatic patients before six weeks of amenorrhea and with no feature of intrauterine nor of ectopic pregnancy at traditional bidimensional ultrasonography were considered. Laparoscopy showed ectopic pregnancy in 9 cases. 3D transvaginal ultrasonography preceeding laparoscopy showed small ectopic gestational sac in 4 cases. Moreover the fallopian tube on the side of ectopic pregnancy could be imaged in all cases. This was possible because the fallopian tube was surrounded by a fine hypoechogenic border, an apparently specific feature which had not been reported previously. These preliminary data suggest that 3D ultrasonography is an effective procedure for early diagnosis of ectopic pregnancy in asymptomatic patients before six weeks of amenorrhea.     

经阴道超声对异位妊娠的诊断价值

目的:探讨经阴道超声对异位妊娠的诊断价值。方法:回顾分析127例经手术、病理证实的异位妊娠的声像图特征。结果:经阴道超声检查漏诊2例,误诊2例,异位妊娠超声检出率及定位正确率为96．8%。结论:经阴道超声对异位妊娠的诊断有较大的临床应用价值。     

Diagnosis of extrauterine pregnancy with transvaginal ultrasound

We reviewed all cases of suspected ectopic pregnancy (EP) that had transvaginal ultrasound (TVU) prior to surgery from 1987 to 1989. Of 265 patients who had culdocentesis and laparoscopy for suspected EP, 206 had EP. IN 28 of the 59 cases that proved negative at laparoscopy, EP was suspected at TVU. An ectopic embryo was seen at TVU in 28 cases where laparoscopy confirmed the TVU diagnosis. In 163 cases where EP was considered probable at TVU this was confirmed at laparoscopy. 15 cases of EP were overlooked at TVU.     

Ultrasound diagnosis of ectopic pregnancy

The diagnosis of tubal ectopic pregnancy should be based upon the positive visualization of an adnexal mass using transvaginal ultrasound rather than the absence of an intrauterine gestational sac. Ultrasound diagnosis earlier in the natural history of the condition has meant that more conservative treatment options can be considered and implemented in clinically stable women. Although laparoscopy traditionally is accepted as the gold standard in the diagnosis of tubal ectopic pregnancy, there is substantial evidence that transvaginal ultrasound is the diagnostic tool of choice in modern practice. In expert hands, this single noninvasive and reproducible diagnostic test correlates well with the presence of ectopic pregnancy at the time of surgery. This article discusses the use of ultrasound as a single stand-alone test in the diagnosis of tubal ectopic pregnancy.     

Ectopic pregnancy. I. Diagnostic-therapeutic algorithm used in clinics at the Gynecology Department of the Polish Mother's Memorial Institute

In prospective study from 1988 to 1992 I analysed possibility of early non-invasive detection and treatment of ectopic pregnancy. In this purpose I used a gynecological examination, estimation of concentration of beta-hCG and progesterone in serum, transvaginal ultrasound and in certain patients, curettage. The fusion of all these methods permits to gain right diagnosis of ectopic pregnancy. In this work I described diagnostic and therapeutic algorithm of ectopic pregnancy allows in using conservative treatment in this pathology. Empty uterus (without gestational sac) in transvaginal ultrasound examination, in cases with beta-hCG concentration is higher than 3000 mIU/ml, allows recognise ectopic pregnancy. I introduced predictive scale for possibilities of conservative treatment and therapeutic algorithm allows to chose way of treatment (laparatomy, laparoscopy, Methotexate i.m. expectant management). The estimation of clinical value of diagnostic algorithm for ectopic pregnancy will present in part II and efficacy of conservative treatment methods in patients with ectopic pregnancy in part III.     

Transvaginal ultrasonography in patients at risk for ectopic pregnancy

Transvaginal ultrasonography was performed in 139 patients at risk for ectopic pregnancy. Among these patients, 22 ectopic pregnancies and 117 intrauterine pregnancies were eventually confirmed. Transvaginal ultrasonography definitively identified 18 of 22 (82%) ectopic pregnancies at initial evaluation by either direct visualization of an ectopically placed gestational sac (N = 14) or failure to visualize an intrauterine gestational sac combined with a level of the beta-subunit of human chorionic gonadotropin greater than 1300 mIU/ml (First International Reference Preparation) (N = 4). Transvaginal ultrasonography definitively diagnosed 103 of 117 (88%) intrauterine pregnancies at initial evaluation. Eighteen patients could not be definitively diagnosed by transvaginal ultrasonography at initial evaluation because nonvisualization of a gestational sac and a beta-subunit of human chorionic gonadotropin value less than 1300 mIU/ml. Evaluation of this group with serial measurements of beta-subunit of human chorionic gonadotropin, repeat ultrasonography, or both, revealed ectopic gestation (N = 4), early intrauterine pregnancy (N = 4), and complete abortion (N = 10).     

Reliability of transvaginal ultrasound in detecting first trimester pregnancy abnormalities

OBJECTIVE: To evaluate the reliability of transvaginal ultrasound (US) and human chorionic gonadotropin (hCG) levels in detecting early abnormalities and predicting outcome of pregnancy. PATIENTS: One hundred thirty-two patients were studied, of which 113 had an intrauterine pregnancy and 19 had an ectopic pregnancy (EP). RESULTS: In 78 with singleton normal pregnancies, US revealed a normal crown-rump length, heart motion, and hCG levels between 1,000 to 107,000 mIU/mL. Of 16 patients with small crown-rump length, heart motion present, and normal hCG levels, 6 aborted and 10 reached term. Thus, 6 of 84 (7.14%) singleton with fetal heart motion aborted. Thirteen with small crown-rump and absent heart motion also aborted. All 8 with an empty gestational sac aborted. In 8, transvaginal US detected four twins, two triplets, and two quadruplets, whereas hCG was not discriminative. Transvaginal US revealed an empty uterus in 19 patients with an EP, whereas serum hCG varied between 37 and 10,500 mIU/mL. CONCLUSION: A fetal crown-rump length compatible with gestational age and fetal heart motion seen by transvaginal US can predict a term pregnancy in greater than 90% of patients.