Dopplerdiagnostik der ektopen Schwangerschaft. Ein diagnostischer Zugewinn?

Abstract

In spite of improved laboratory methods and better resolution by using endovaginal sonography diagnosis of ectopic pregnancy remains an unresolved diagnostic problem. Because of early disturbed development serum HCG discriminatory levels as well as sonographic evaluations are of limited value. The typical symptoms of ectopic pregnancy are represented only in 50% of patients, and hence extra- and intrauterine signs are used for the detection of ectopic pregnancy. Only if diagnosis is performed at a very early stage is it possible to avoid emergency situations and to maintain optimal fertility chances. Therefore we wanted to know whether Doppler evaluation improves the diagnostic performance. 83 women with suspected ectopic pregnancy were examined. In 24 cases peritrophoblastic flow could be measured, but 19 of them also had small amounts of free intraperitoneal fluid. An exact relation of the HCG values (85 - 8500 mlE/ ml) to the velocity indices (6-31 cm/s, RI 0.44-0.87) was not available. Colour flow imaging and pulsed Doppler examination are qualified, especially if there are extrauterine signs, to identify ectopic pregnancy and to increase diagnostic sensitivity from 65% to 86% at an early stage.