OP02.07: Ectopic pregnancy: how accurate is ultrasound in the diagnosis

Abstract

To evaluate the diagnostic accuracy of Ultrasound in the diagnosis of ectopic pregnancy compared to operative findings in women undergoing surgical management. Prospective observational study in a University hospital of 6444 consecutive women who underwent ultrasound for early pregnancy problems in 2008 and 2009. Data was collected from astria ultrasound database and evaluation of clinical notes. Excel spreadsheet was used for data analysis. 138 women diagnosed with ectopic pregnancy on pelvic ultrasound who underwent surgical management, ultrasound features were compared with surgical findings and histological diagnosis. Ectopic pregnancy was diagnosed with TAS/TVS if one or more of the following signs were noted. 1. Non cystic adnexal strcture. 2. Ectopic gestational sac with or without fetal heart. 3. Empty uterus + echogenic free fluid in pouch of Douglas. Women who underwent medical or expectant management of ectopic pregnancy were excluded. 6444 women had TAS/TVS for early pregnancy problems, out of which 138 women were diagnosed with ectopic pregnancy. 138 (2.1%) women were diagnosed with ectopic pregnancy. 135 (97.8%) were symptomatic. 97 (70%) did not have any risk factors for any ectopic pregnancy. 113 (81.8%) had adnexal mass, 12 (8.6%) had live ectopic pregnancy, 20 (14.4%) had ectopic gestational sac. 100 (72.4%) had echogenic free fluid in POD. 6 (4.3%) women had negative laparoscopies. The sensitivity of ultrasound was 91%, specificity was 99% to detect ectopic pregnancy. Positive predictive value of ultrasound was 95.6% and negative predictive value was 99.8%. High resolution transvaginal ultrasound is the gold standard in diagnosing ectopic pregnancies. In our study 91% of ectopic pregnancy was accurately diagnosed with ultrasound alone thereby significantly reducing the number of negative laparoscopies.