Transvaginal ultrasonography in patients at risk for ectopic pregnancy

Article Abstract:

Ectopic pregnancy, the implantation of the products of conception outside of the uterus, can cause the death of the mother. An ectopic pregnancy is suspected when there is an elevation of human chorionic gonadotropin hormone (HcG), the hormone signalling pregnancy, without evidence of a fetus in the uterus according to results of conventional abdominal ultrasound testing. Ultrasound, the use of high frequency sound to visualize internal structures, can be performed abdominally or transvaginally, that is, using a probe placed inside the vagina, to visualize the inside of the uterus and ovaries. To determine whether transvaginal ultrasound is effective in diagnosing ectopic pregnancies, 139 patients at risk were evaluated. Normal pregnancies inside the uterus were found in 117 patients; ectopic pregnancies were diagnosed in 22 pregnancies. A product of conception, the gestational sac, was either directly seen by ultrasonography to be ectopically placed or else it could not be visualized in the uterus and there was elevated HcG in 18 of the 22 ectopic pregnancies. Eighteen patients could not be diagnosed initially because of poor visualization of a gestational sac and low levels of HcG; repeat evaluations revealed four ectopic pregnancies, four pregnancies in the uterus, and 10 spontaneous abortions. It is concluded that transvaginal ultrasonography is more sensitive than abdominal ultrasonography and is thus a useful tool in assessing the location of a gestational sac.

Image processing, Prenatal ultrasonography, Ultrasonics in obstetrics

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Ultrasonographic evaluation of uteroplacental blood flow patterns of abnormally located and adherent placentas

Article Abstract:

To learn more about the patterns of blood flow between the uterus and the placenta, 76 pregnant women (at different stages of pregnancy) with the symptom of bleeding were studied. The women were also suspected of having placenta previa, a condition in which the placenta is located abnormally near the cervical os (opening of the uterus), associated with bleeding in late pregnancy. Studies using transvaginal ultrasonography (an approach that allows evaluation of blood flow) indicated that 16 patients had persistent placenta previa, of whom 10 demonstrated lacunar blood flow patterns (pooling of blood in 'lakes' throughout the placenta). Eight of these 10 were followed-up: of these, seven had placentas that were abnormally adherent to the uterus, and their deliveries were associated with extensive blood loss. Six patients without lacunar flow patterns had persistent placenta previa, but did not suffer hemorrhagic complications. A discussion is provided of blood flow patterns at the uteroplacental border. Since the presence of lacunar blood flow patterns suggests that blood loss will be likely, it is recommended that patient and anesthesiologist be fully informed of the possibility prior to delivery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Blood flow, Blood flow measurement, Complications and side effects, Placental diseases, Placenta diseases, Placenta praevia, Placenta previa, Diagnosis, Ultrasonic, Diagnostic ultrasonography

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The use of transvaginal ultrasonography in the diagnosis of ectopic pregnancy

Article Abstract:

Ectopic pregnancies, in which the fertilized egg is implanted outside of the uterus, are life-threatening. Diagnosis is made using serial measurements of the hormone human chorionic gonadotropin, which is elevated in pregnancy, and ultrasound, the use of high frequency sound waves to visualize internal structures. Transvaginal ultrasound is a new diagnostic tool that uses a small probe into the vagina. In 145 women suspected of having ectopic pregnancy, traditional abdominal ultrasound revealed 38 ectopic pregnancies. The remaining 107 patients had further evaluation with transvaginal ultrasound. Of these, transvaginal ultrasound definitely ruled out 56 ectopic pregnancies and diagnosed another 39. Fetal heart beats were detected in the fallopian tubes of 23 percent of the patients, and in two thirds of the women, unruptured tubal pregnancies were found. The use of high frequency transvaginal probes improves the diagnosis of ectopic pregnancies and has application in early diagnosis of unruptured tubal pregnancies already indicated by hormone blood levels.

Methods, Chorionic gonadotropin, Chorionic gonadotropins

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