Accuracy of transvaginal ultrasound and serum hCG in the diagnosis of ectopic pregnancy.

Transvaginal ultrasound was performed upon admission of 127 patients with a clinical suspicion of ectopic pregnancy in association with human chorionic gonadotropin (hCG) determination. Failure to visualize with sonography an intrauterine gestational sac with an hCG level superior to 1000 mIU/ml identified 25/42 tubal pregnancies with a positive predictive value of 86% and a specificity of 93%. Abnormal adnexal findings occurred in 95% of the ectopic pregnancies. Extrauterine gestational sacs with or without embryos could be confidently detected in 19 ectopic pregnancies (45%). A complex adnexal mass was seen in 19 cases and yielded a positive predictive value of 90% (19/21). Adnexal gestational sacs and complex masses were seen more frequently in those ectopic pregnancies with an hCG level above 1000 mIU/ml but the difference was not significant (100% versus 78%). Simple adnexal cysts were found more frequently in intrauterine pregnancies, and fluid in the cul-de-sac was also not indicative of ectopic pregnancy (positive predictive value, 29%). Transvaginal ultrasound has a primary role in the diagnosis of ectopic pregnancy. The combined use of uterine and adnexal sonography associated with elevated hCG levels allows a definitive diagnosis in the vast majority of cases at a very early stage, when the chances for a successful conservative treatment are greater.     

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

The purpose of this study 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 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. Positive 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. Prospective randomized trials will determine the ultimate clinical value of these findings.     

Echogenic adnexal masses associated with first-trimester pregnancy: sonographic appearance and clinical significance

In a retrospective survey of a large obstetrical ultrasound experience, 10 echogenic adnexal masses in nine patients with a coexistent intrauterine pregnancy were detected and analyzed. Definitive follow-up data available for seven of the nine patients disclosed three ovarian teratomas, two hemorrhagic corpus luteum cysts, one endometrioma, one inflammatory mass, and one colonic pseudomass. In one additional patient, an echogenic ectopic pregnancy with an intrauterine pseudogestational sac simulated the above entities. Conservative management with follow-up sonography is generally indicated for echogenic masses coexistent with first-trimester intrauterine pregnancies.     

Pitfalls in the transvaginal sonographic diagnosis of ectopic pregnancy

Transvaginal sonograms (TVS) of 40 adequately documented ectopic pregnancies were reviewed retrospectively. Difficulties that interfered with the accurate demonstration of the adnexal mass of the ectopic pregnancy were identified in 21 of these studies (52.5%). In three cases (7.5%) the ectopic pregnancy was visualized in an erroneous location. In 11 cases (27.5%), the ectopic pregnancy was overshadowed by coexisting pathologic findings, misinterpreted as a bowel segment or poorly demarcated from the adjoining ovary. In seven cases (17.5%), the adnexal mass of an ectopic gestation was completely over-looked on initial TVS. TVS in the women suspected of having an ectopic pregnancy must be performed meticulously and with due consideration to the pitfalls described.     

经阴道超声对异位妊娠单剂量氨甲喋呤治疗结果的预测价值

目的研究经阴道超声对异位妊娠氨甲蝶呤（MTX）治疗结果的预测价值。方法回顾性总结106例经MTX治疗的异位妊娠患者的经阴道超声声像图表现。结果异位妊娠囊内探及胎心及卵黄囊者均治疗失败。异位妊娠包块小于1．5cm的病例均治疗成功。治疗成功组和治疗失败组在1．5cm以上包块大小、包块表现形式、盆腔积液、低阻动脉血流的存在等方面的差异均无显著性意义。结论经阴道超声二维声像图表现对预测异位妊娠MTX治疗结果有一定价值，彩色多普勒血流成像的预测价值尚需进一步研究。     

经阴道超声诊断卵巢妊娠价值的初步探讨

目的评价经阴道超声对卵巢妊娠的诊断价值。方法回顾性分析21例卵巢妊娠的超声图像特征，并与手术及病理结果进行对照分析。结果所有病例经阴道超声检查均诊断为宫外孕，9例未破裂型卵巢妊娠中，经阴道超声检查进一步提示部位在卵巢者3例，在卵巢表面者3例，部位不清者1例，误诊为输卵管妊娠2例，定位符合率66．7％；12例破裂型卵巢妊娠中，经阴道超声检查均未进一步提示病灶部位。其声像图特征为：子宫正常或略大，宫腔内未见胚囊；卵巢内部或表面见完整的胚囊结构或不均质强回声；或附件区见杂乱不均质回声，其内可测及或未测及完整的胚囊结构，盆腹腔常见多量游离液体。结论经阴道超声对未破裂型卵巢妊娠的术前诊断有一定价值。     

经阴道超声在异位妊娠诊断及治疗中的应用价值

目的 探讨经阴道超声(TVS)在异位妊娠诊断及治疗中的应用价值.方法 对116例临床确诊为异位妊娠患者的临床资料及经阴道超声声像图表现进行回顾性分析.结果 116例异位妊娠患者声像图表现为6种类型:(1)妊娠囊型28例,囊内见卵黄囊和(或)胚芽稍高回声,有或无胎心搏动;(2)囊性团块型36例,团块内见条状稍高回声,未见搏动性回声;(3)混合型33例,为附件区或子宫旁实质与液性回声混合,有盆腔积液;(4)实质团块型16例,附件区较低回声不均质团块;(5)宫颈妊娠囊样结构1例,子宫体部内膜线清晰,宫颈明显增大,内见妊娠囊样图形;(6)宫内宫外同时妊娠2例,子宫内外均见妊娠囊回声.本组病例均经TVS 结合临床及实验室检查确诊,93例经手术治疗,23例药物保守治疗治愈.结论 TVS在异位妊娠诊断和指导临床治疗中有重要应用价值.     

Sonographic findings of transvaginal color Doppler ultrasound in ectopic pregnancy

Purpose The objective of this study was to retrospectively assess whether the sonographic findings from transvaginal color Doppler ultrasound (TV-CDU) are helpful in the diagnosis of ectopic pregnancy. Methods Thirty-four patients who received surgery for ectopic tubal pregnancies were preoperatively evaluated using TV-CDU. The presence or absence of color vascularity within the ectopic masses was examined. The relationship between the presence or absence of blood flow in the tubal mass and the corpus luteum cyst, or the serum β-hCG values, was evaluated. Results Color vascularity within the adnexal mass was detected in 27 of 34 (79.4%) patients with ectopic pregnancies by TV-CDU. Color vascularity within the mass was observed in 18 of 24 (75.0%) patients with a questionable adnexal mass that had no obvious gestational sac in B-mode images. Moreover, color vascularity was seen in all four patients with a serum β-human chorionic gonadotropin (β-hCG) value of less than 500 mIU/ml. However, it was difficult to identify the blood flow of the adnexal mass in six of the nine (66.7%) patients with a corpus luteum cyst in the ipsilateral ovary. No relationship was observed between the serum β-hCG concentrations and the resistance indices, or the peak systolic velocity. Conclusions The detection of color vascularity by TV-CDU in patients with an ectopic pregnancy is helpful for diagnosis, especially for patients with either a questionable adnexal mass in B-mode images or lower serum β-hCG concentrations.     

Sonographic diagnosis of ectopic pregnancy with endovaginal probes: what really has changed?

To evaluate the impact of endovaginal (EV) sonography in the diagnosis of ectopic pregnancy, a 2 year retrospective study was performed identifying 123 at-risk patients. Of these 123 women, 19 (15.4%) had a surgically proved ectopic pregnancy, only three (15.8%) of which were visualized directly at sonography. A confident diagnosis of an intrauterine pregnancy (IUP) was made at the initial scan in 74%, which contrasts with 58% diagnosed at the first transabdominal (TA) scan in an earlier study from this laboratory, thus confirming an improvement in diagnostic ability with EV transducers. This study has failed to confirm some findings of other workers, particularly that adnexal ring-like structures are visualized frequently in the presence of an ectopic pregnancy. No adnexal rings were observed in our 19 cases. The combination of an adnexal mass and free pelvic fluid was found to correlate best with the presence of an ectopic pregnancy. This study further emphasizes that a significant proportion (26.3%) of ectopic pregnancies have a normal EV sonogram at presentation. The group failing to demonstrate an IUP and showing no evidence of an adnexal mass or pelvic fluid (i.e., a normal pelvic sonogram) carried a 1:3 risk for the presence of an ectopic pregnancy, a result that is very similar to our data published before the introduction of EV technology. We conclude that, although it provides a significant improvement and refinement in the recognition of intrauterine pregnancies, EV scanning does not permit a confident diagnosis of ectopic pregnancy in many cases.     

Comparison of tubal ring and corpus luteum echogenicities: a useful differentiating characteristic.

The purpose of this report is to compare the echogenicity of the tubal ring of an ectopic pregnancy and the corpus luteum with that of the ovary for improved detection of early ectopic pregnancy. In patients with ectopic pregnancy diagnosed at sonography on the basis of the presence of an adnexal tubal ring, echogenicity of the ring was compared with the echogenicity of the ovarian parenchyma. Twenty-six patients with tubal rings containing either a yolk sac or cardiac activity were included. Twenty-three (88%) of the 26 tubal rings had echogenicity equal to or greater than that of ovarian parenchyma. In 13 patients with ectopic pregnancy diagnosed on the basis of an empty tubal ring, 10 rings (77%) were more echogenic than the ovary. In 45 control patients with intrauterine pregnancy, the corpus luteum was more echogenic than the ovary in only 3 (7%). The tubal ring of an ectopic pregnancy is usually more echogenic than ovarian parenchyma, and the corpus luteum is usually equal to or less echogenic than the ovary. Echogenicity of an adnexal mass may help distinguish the tubal ring of an ectopic pregnancy from a corpus luteum.     

Transvaginal sonographic diagnosis of live monochorionic twin ectopic pregnancy.

Ectopic pregnancy is a leading cause of pregnancy-related deaths; its incidence has progressively increased in recent years. Spontaneous twin ectopic pregnancy, however, is extremely rare. Among more than 100 reported cases of twin tubal pregnancies, only 5 cases in which fetal cardiac motion has been visualized in both embryos have been reported. We describe an additional case of a live monochorionic twin ectopic pregnancy in a patient with no predisposing factor. With transabdominal sonography, we initially diagnosed a single ectopic pregnancy, visualized as an ill-defined mass in the left adnexa. However, with transvaginal sonography, we determined the left adnexal mass to contain a single monochorionic gestational sac with 2 embryos, each with cardiac motion. These findings were confirmed with color Doppler sonography and at laparotomy. The introduction of high-resolution transvaginal sonography has resulted in the earlier diagnosis of ectopic pregnancy and has contributed to a recent decrease in the maternal mortality and morbidity associated with this condition.     

经阴道超声对未破裂型宫外孕的诊断应用

目的 探讨经阴道超声(TVS)及时准确诊断未破裂型宫外孕的检查方法.方法 回顾性分析我院2004年1月-2005年1月确诊的64例未破裂型宫外孕患者的超声检查资料.具体方法是先行常规超声检查显示子宫及卵巢后注意追踪显示输卵管;后行TVS扫查子宫以上部位,并与肠管回声鉴别;用探头反复轻推,根据可疑病灶与卵巢是否同步运动以辨别其与卵巢的关系. 结果 64例均显示附件区妊娠囊样环状回声.根据声像图显示中妊娠囊样环状回声与输卵管及卵巢的关系分为3型:Ⅰ型:输卵管可显示型(29例):较清楚显示输卵管,管内可见妊娠囊样环状回声;其中5例于初检漏诊后注意追踪显示输卵管而提示宫外孕诊断;Ⅱ型:与卵巢分界清型(27例):6例于初检漏诊后注意扫查子宫底以上部位、并与肠管回声鉴别而提示宫外孕诊断;Ⅲ型:与卵巢分界不清型(8例):7例在反复轻推探头后辨别与卵巢是否同步运动而提示宫外孕诊断.结论 TVS在检查方法上的完善有助于更及时、准确地诊断未破裂型宫外孕.     

经阴道超声诊断宫外孕

目的：探讨经阴道超声诊断宫外孕的方法及其临床应用。方法：对临床上有不规则阴道流血史的病人,应用经阴道超声检查186例。将其分为未破型宫外孕和出血型宫外孕两大类,进行比较分析。结果：孕囊完好无损88例,不全流产42例,流产合并大出血30例,误诊10例。超声诊断与病理诊断符合率94．1％。结论：经阴道超声检测较经腹部超声检查能更早期的获取最佳图像,是诊断早期宫外孕的有效方法且检出率高。     

经腹彩超和经阴道超声诊断异位妊娠的临床应用价值及有效性

目的比较经腹彩超(TAS)与经阴道超声(TVS)诊断异位妊娠的临床应用价值及有效性。方法选取我院2018年1月至2018年12月收治的120例异位妊娠患者作为研究对象,均行TAS扫查与TVS扫查。以病理诊断结果为检验金标准,比较两种超声扫查方法的诊断准确率。结果TAS扫查诊断准确率为74.17%,显著低于TVS扫查的90.83%(P<0.05)。TVS扫查对宫外混合性团块、宫外孕囊影、孕囊影中胚芽检出率高于TAS扫查,差异具有统计学意义(P<0.05);两种超声扫查方法对胎心检出率比较,差异无统计学意义(P>0.05)。结论相较于TAS扫查,TVS扫查可更有效地诊断早期异位妊娠,同时,TAS扫查仍是异位妊娠诊断中的一个重要的辅助检查方法。     

Sonographic evaluation of ectopic pregnancy

To assess sonographic findings in the evaluation for ectopic pregnancy, all women referred over a two-year period were prospectively evaluated. The incidence of intrauterine as well as adnexal findings was assessed in an attempt to optimize sonographic evaluation. Visualization of a double decidual sac sign (DDSS) within the uterus provided an accurate means of confirming an intrauterine pregnancy (IUP) prior to embryo visualization. Forty-two of 130 women with IUP were diagnosable only by the DDSS. As a screening test for ectopic pregnancy, sonographic documentation of an IUP provided the only convincing evidence for the absence of an ectopic gestation. Any woman clinically at risk for ectopic pregnancy whose sonogram did not confirm the presence of an intrauterine pregnancy was at relatively high risk (43 per cent) for having an ectopic gestation. Characterization of adnexal findings increased the level of risk for ectopic pregnancy in these women to 70-100 per cent. However, 20 per cent of women with a surgically confirmed ectopic pregnancy had normal adnexal findings.     

Ectopic pregnancy: a review

Ectopic pregnancy is a major clinical problem, occurring in 75,000 cases per year in the United States. With in vitro fertilization, embryo transfer, microsurgical techniques, and better early diagnosis, the rates of ectopic pregnancies have increased. Transvaginal sonography along with beta-human chorionic gonadotrophin monitoring are the standards for evaluation of suspected ectopic pregnancy. When ectopic pregnancy is present, transvaginal sonography most often demonstrates an adnexal finding directly related to the extra-uterine gestation itself, a hematoma caused by it, or both. Although tubal location is most common, it is important to recognize unusual locations of ectopic pregnancy such as isthmic, cervical, ovarian, and abdominal. Ultrasound is the mainstay of diagnosis, but magnetic resonance imaging can be helpful in unusual or complicated cases. Current therapeutic options for an ectopic pregnancy are expectant management, systemic methotrexate injections, sonographically guided minimal invasive treatment, and surgery. This review encompasses diagnosis, treatment, and management of ectopic pregnancy.     

First trimester bleeding evaluation

First trimester bleeding is a common presentation in the emergency room. Ultrasound evaluation of patients with first trimester bleeding is the mainstay of the examination. The important causes of first trimester bleeding include spontaneous abortion, ectopic pregnancy, and gestational trophoblastic disease; 50% to 70% of spontaneous abortions are due to genetic abnormalities. In normal pregnancy, the serum beta hCG doubles or increases by at least 66% in 48 hours. The intrauterine GS should be visualized by TVUS with beta hCG levels between 1000 to 2000 mIU/mL IRP. Visualization of the yolk sac within the gestational sac is definitive evidence of intrauterine pregnancy. Embryonic cardiac activity can be identified with CRL of >5 mm. A GS with a mean sac diameter (MSD) of 8 mm or more without a yolk sac and a GS with an MSD of 16 mm or more without an embryo, are important predictors of a nonviable gestation. A GS with a mean sac diameter of 16 mm or more (TVUS) without an embryo is a sonographic sign of anembryonic gestation. A difference of <5 mm between the mean sac diameter and the CRL carries an 80% risk of spontaneous abortion. Approximately 20% of women with first trimester bleeding have a subchorionic hematoma. The presence of an extra ovarian adnexal mass is the most common sonographic finding in ectopic pregnancy. Other findings include the tubal ring sign and hemorrhage. About 26% of ectopic pregnancies have normal pelvic sonograms on TVUS. Complete hydatidiform mole presents with a complex intrauterine mass with multiple anechoic areas of varying sizes (Snowstorm appearance). Twenty-five percent to 65% of molar pregnancies have associated theca-leutin cysts. Arteriovenous malformation of the uterus is a rare but life-threatening cause of vaginal bleeding in the first trimester. The sonographic findings in a patient with first trimester bleeding should be correlated with serum beta hCG levels to arrive at an appropriate clinical diagnosis.     

Ectopic pregnancy: transvaginal sonographic findings of 152 cases.

In a retrospective study performed on 152 cases of verified ectopic pregnancy, the features at transvaginal sonography were evaluated. A total of 146 (96%) of the patients had at least one abnormal sonographic feature and pelvic/cul-de-sac fluid was the most common finding, detected in all of the 146 patients. Pelvic/cul-de-sac fluid was particulate in 103 patients and simple in 43. Pelvic/cul-de-sac fluid together with extrauterine findings were found to be present in 93.8% (137/146) of the patients, suggesting the fact that if pelvic/cul-de-sac fluid was detected, every effort should be made to image the tube. The extrauterine transvaginal sonographic features included 102 (63.0%) patients with a mass, 60 (41.1%) with a gestational sac (with or without yolk sac or embryo), and eight (5.3%) with a living embryo. Comparison of the sonographic findings according to the status of the ectopic pregnancy revealed that particulate fluid (98.9%), and an extra-uterine mass (88.2%) were the features that aided in the diagnosis of ruptured and aborted ectopic pregnancies, whereas an extrauterine gestational sac (72.9%), and a living embryo (11.9%) were associated with intact ectopic pregnancies. Our findings support the practice of using transvaginal sonography, and ss-human chorionic gonadotropin measurements in the diagnosis and prediction of the status of ectopic pregnancy.     

Value of the yolk sac in evaluating early pregnancies

To determine the potential value in identifying a yolk sac in women with suspected ectopic pregnancies, 211 consecutive women who were referred to pelvic sonography with this clinical indication were prospectively studied. Of the 211 patients examined, 104 proved to have a normal intrauterine pregnancy (IUP), 59 had an abnormal (nonviable) IUP, and 48 had a surgically-proven ectopic pregnancy. Considering only intrauterine "sacs" that lacked a visible embryo, a yolk sack was identified in 16 of 26 (62%) normal IUPs, and 3 of 19 (16%) abnormal IUPs, but was not seen in any of six pseudo-gestational sacs in women with ectopic pregnancies. In comparison, a double decidual sac (DDS) finding was thought to be present in 24 of 26 (92%) normal gestational sacs, 12 of 19 (63%) abnormal gestational sacs, and 2 of 6 (33%) pseudogestational sacs. We conclude that in women in whom a living embryo is not identified, demonstration of a yolk sac is reliable evidence for early IUP, and virtually excludes the possibility of an ectopic gestation. Although a yolk sac is less frequently observed than a DDS finding, it is also more specific evidence for an IUP. Careful attention to the yolk sac should permit earlier, more reliable diagnoses of IUP than previously possible.     

Ultrasonic characteristics of pelvic inflammatory masses

Twenty patients with pelvic abscesses diagnosed either at surgery or from typical clinical findings underwent sonography. Seventeen of the twenty patients had inflammatory processes of gynecological origin. In the main, two patterns were observed. The more common pattern was a small, round adnexal or cul de sac mass with a slightly irregular border. The other pattern consisted of large, rough-bordered, multilocular masses that obscured the uterus. In single cases confusion had occurred between pelvic abscesses, fibroids, and chronic ruptured tuba1 pregnancy. The role of ultrasound in the management of patients with tuboovarian abscesses is discussed.