title: Adnexal sonographic findings in ectopic pregnancy and their correlation with tubal rupture and human chorionic gonadotropin levels.
abstract: OBJECTIVE
  To determine whether the distribution of transvaginal sonographic findings of ectopic pregnancy has changed since the studies done 20 years ago and to explore the correlation of tubal rupture with transvaginal sonographic findings and human chorionic gonadotropin (hCG) levels.
  
  
  METHODS
  Patients with ectopic pregnancy who underwent transvaginal sonography before treatment were included. Sonograms and medical records were retrospectively reviewed. The presence of a tubal ring, the presence of a yolk sac, embryonic cardiac activity, the degree of vascularity on color Doppler imaging, hCG levels, and results of surgery were recorded.
  
  
  RESULTS
  Our study included 231 ectopic pregnancies. A positive sonographic adnexal finding was present in 219 cases (94.8%): adnexal mass in 218 (94.4%) and a moderate-to-large amount of free fluid in 84 (36.4%). The adnexal masses were graded as follows: 1, nonspecific mass (125 cases [54.1% of total]); 2, tubal ring without a yolk sac or embryo (57 [24.7%]); 3, yolk sac but no embryonic heartbeat (19 [8.3%]); and 4, embryo with cardiac activity (17 [7.4%]). The mean hCG level increased as the grade ascended from 1 to 4. Thirty-six patients had tubal rupture at surgery within 24 hours of the sonogram. A moderate-to-large amount of free fluid was significantly associated with tubal rupture (P < .05) but had low sensitivity, specificity, and positive predictive value for rupture. Other sonographic findings and hCG levels were not significantly related to tubal rupture.
  
  
  CONCLUSIONS
  Transvaginal sonography showed an adnexal abnormality in nearly 95% of our patients with ectopic pregnancy, most commonly a nonspecific adnexal mass. Embryonic cardiac activity was seen in fewer than 10%. Neither sonographic findings nor hCG levels were useful predictors of tubal rupture.
authors.affiliation: Department of Radiology, Brigham and Women's Hospital Harvard Medical School, 75 Francis St, Boston, MA 02115 USA. mfrates@partners.org.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Frates
authors.forename: Peter M
authors.initials: PM
authors.lastname: Doubilet
authors.forename: Hope E
authors.initials: HE
authors.lastname: Peters
authors.forename: Carol B
authors.initials: CB
authors.lastname: Benson
mesh_terms: D000291:Adnexal Diseases / Q000097:blood / Q000175:diagnosis*; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011274:Pregnancy, Tubal / Q000097:blood / Q000175:diagnosis*; D015203:Reproducibility of Results; D012422:Rupture, Spontaneous; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D016216:Ultrasonography, Prenatal / Q000379:methods*; D014597:Uterine Rupture / Q000097:blood / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin
keywords: ectopic pregnancy; human chorionic gonadotropin; obstetric ultrasound; transvaginal; tubal rupture