Sonographic determination of tubal rupture in patients with ectopic pregnancy: is it feasible?

Article Abstract:

Early use of ultrasonography (US) to detect ectopic pregnancy (in which the embryo implants somewhere outside the uterus) was considered highly successful. However, over time it was discovered that many ectopic pregnancies were overlooked using US because they did not show the classic signs on a sonogram. Measurement of the levels of human chorionic gonadotropin (hCG), which increase dramatically in early pregnancy, was an additional test used with US. High levels of this hormone, even when US results were negative, indicated the presence of an ectopic pregnancy. Vaginal scanning has also improved the ability to detect ectopic pregnancies, and may even be useful in determining the course of action once an ectopic pregnancy has been diagnosed. The ability of a vaginal US scan to determine not only the presence, but also the status, of an ectopic pregnancy is needed if US is to help in deciding the course of action. The status involves whether the ectopic pregnancy is located in an intact or ruptured fallopian tube (a common location for ectopic pregnancies). Strict criteria for evaluating the scan must be used to make determinations of status. However, this may result in a loss of sensitivity in the detection of ectopic pregnancies. The vaginal scan is better able to visualize dilated fallopian tubes and their contents than an abdominal scan. Ring-like structures in the tubes indicate that they are intact. There also seems to be a correlation between intact tubes and increased hCG levels. Using US to diagnose ectopic pregnancy and to determine if the fallopian tube is intact or ruptured appears promising. Recent research has shown favorable results with its use, but further research must be done to confirm these results and to further clarify how US should be used. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Can the status of tubal pregnancy be predicted with transvaginal sonography? A prospective comparison of sonographic, surgical, and serum hCG findings

Article Abstract:

The treatment of an ectopic pregnancy, in which the embryo implants somewhere outside the uterus, requires precise information on the location and status of the pregnancy. Currently, treatment choices are based on the combination of information obtained from diagnostic surgical procedures and blood levels of the hormone, human chorionic gonadotropin (hCG). Transvaginal sonography, which uses ultrasound to form images of the pelvic organs, is a potentially useful technique for assessing ectopic pregnancies located in the fallopian tubes. This study compared the findings of sonography with those of the traditional diagnostic methods, in a group of 120 ectopic pregnancies. The pregnancies were all tubal ectopic pregnancies. In 74 of the 120 women (62 percent), sonography showed a ring indicative of an ectopic gestational sac; surgery showed the fallopian tubes in these women to all be intact (an ectopic pregnancy can cause the tube to rupture). Sonography in 39 of the women showed an adnexal (adjacent) mass. In this group of 39, surgery showed that 20 had blood clots in their fallopian tubes, seven had incomplete tubal abortions, and six had ruptured fallopian tubes. The size of the masses as measured by sonography correlated closely with measurements made in surgery. Sonography correctly diagnosed tubal pregnancy in 94 percent of the cases studied. It also helped diagnose masses that were high in the tubes before the tubes were severely damaged. This early diagnosis could facilitate treatment to prevent tubal damage. The diagnosis of ruptured tubes by sonography is less clear and needs to be studied further. Sonography appears to be a viable alternative to invasive surgery in the diagnosis of ectopic pregnancies. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Extrauterine findings of ectopic pregnancy at transvaginal US: importance of echogenic fluid

Article Abstract:

An ectopic pregnancy occurs when the embryo implants anywhere outside the uterus. Early detection is important in treating this abnormality. Ultrasound (US) is often used to evaluate pregnancies which are thought to be ectopic. US is an imaging technique using high-frequency sound waves. Transvaginal (through the vagina) US has been found to be more accurate in detecting these disorders than transabdominal (through the abdomen) US, and it also can detect and characterize intraperitoneal pelvic fluid (within the lining of the abdominal cavity), which if present in large amounts indicates that ectopic pregnancy is likely. The fluid can be characterized as echogenic (which reflects high frequency sound waves) or anechoic (which does not reflect sound waves). This study examined whether characterization of fluid found by US could be used in diagnosing ectopic pregnancies. Transvaginal US was performed on 232 patients who were pregnant and suspected to have ectopic pregnancies. Any fluid found was characterized, and results from US were compared with other data used to diagnose ectopic pregnancies. It was eventually confirmed that 68 of the 232 patients (29 percent) had ectopic pregnancies and 164 had intrauterine pregnancy (IUP). Intraperitoneal fluid was found in 43 of the 68 patients (63 percent) with ectopic pregnancies, with 38 of the 43 (88 percent) showing echogenic fluid. In 10 (15 percent) of these cases, echogenic fluid was the only abnormal finding based on US. These results indicate that finding echogenic fluid by US in pregnant women clinically suspected of having ectopic pregnancies indicates a high probability of having such pregnancies. (Consumer Summary produced by Reliance Medical Information, Inc.)

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