The use of transvaginal ultrasonography in the diagnosis of ectopic pregnancy.
Despite advances in diagnosis made by the introduction of serum beta-subunit of human chorionic gonadotropin determinations and transabdominal ultrasonography, ectopic gestations still present a major diagnostic challenge. The increased resolution of the transvaginally introduced high-frequency ultrasound transducer probes seems to solve this diagnostic problem. In this study 145 patients were referred for ultrasonographic workup because of a suspected ectopic gestation. In 38 patients a diagnosis could be made with classical transabdominal scanning. One hundred seventeen patients required additional transvaginal scanning with a 5.0 and a 6.5 MHz probe. In 98 patients a diagnosis was made during the first transvaginal scan; nine patients were rescanned within 3 days for the final diagnosis. In 56 patients, ectopic pregnancy was successfully ruled out by transvaginal scanning. Thirty-nine ectopic pregnancies were diagnosed. Only one false-positive identification was made. The sensitivity of diagnosing ectopic pregnancy by high-frequency transvaginal sonography was 100%; the specificity was 98.2%. The positive predictive value of this method was 98%, and the negative predictive value was 100%. The rate of the beating fetal heart was seen in the tube (23%). The high number of unruptured tubal pregnancies in this series (66%) suggests the possibility of an early diagnosis that may have therapeutic implications. The use of higher-frequency transvaginal transducer probes improves the diagnosis of the ectopic gestation.
Timor-Tritsch
I E
IE
Department of Obstetrics and Gynecology, Columbia-Presbyterian Medical Center, New York, NY 10032.
Yeh
M N
MN
Peisner
D B
DB
Lesser
K B
KB
Slavik
T A
TA
D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007813:Laparotomy; D010048:Ovarian Cysts / Q000175:diagnosis; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000601:surgery; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods* / Q000592:standards; D014621:Vagina