1189: Are we Overusing the Term ‘Ectopic not Ruled Out' on Ultrasound Reports?

Abstract

Ectopic pregnancy is a common complaint.Use of TVS and serum BHCG has led to a reduction in the need for diagnostic laparoscopy. However there are many TVS reports that state ‘Ectopic not Ruled Out' (ENRO) in the absence of ultrasound features suggestive of an ectopic pregnancy. Our objectives are to ascertain the management and the outcome of women with the ultrasound diagnosis of ‘ENRO' and to ascertain the sensitivity and specificity of TVS in our department. This prospective study was conducted between 1/11/07 and 1/2/08. Cases were identified at the early pregnancy unit at the John Radcliffe Hospital. Theatre records and ward admissions were checked on a daily basis to include direct admissions. 88 women had a diagnosis of ‘ENRO'. 12(13.64%) had a laparoscopic diagnosis of an ectopic pregnancy. 1(1.14%) woman was lost to follow up. 17(19.32%) had an intrauterine pregnancy and 58(65.91%) had a miscarriage. 1 woman was admitted directly to theatre with an ectopic with no scan. Of the 12 who had ectopic pregnancies, all had the statement ‘ENRO' on their ultrasound report. 9(75%) had adnexal masses, 1(8.33%) had free fluid and 2(16.67%) had no other ultrasound features suggestive of an ectopic pregnancy apart from an empty uterus and a positive urinary BHCG. Based on presence of an adnexal mass on ultrasound and findings at laparoscopy, the transvaginal ultrasound scan has a sensitivity of 75%, specificity of 77.8%. This shows that most women with a report stating ‘ENRO' don't have an ectopic pregnancy.