Role of ultrasonography in diagnosis of ectopic pregnancy with clinical analysis and management in tertiary care hospital.

Abstract

This study is undertaken to emphasize the role of ultrasonography in the diagnosis of ectopic pregnancy and clinical analysis of the same in a tertiary care referral hospital. One hundred patients with provisional diagnosis of ectopic pregnancy were studied. Physical examination, urine pregnancy test, transabdominal scan using 5MHz transducer or transvaginal ultrasonography of 7MHz was done. The diagnosis of ectopic pregnancy was confirmed by direct observation by laparotomy or laparoscopy (which was taken as gold standard). The study showed ectopic pregnancy was most common in gravida 2 and in age group 26-30years with most of them having married life <10years. One or more risk factors were found in 66% of cases. 54% of cases presented with acute symptoms, 14% of cases in shock. Among clinical presentation pain abdomen, history of amenorrhea, bleeding per vaginum, abdominal tenderness, and cervical motion tenderness was most common. In ultrasonography, complex mass in adnexa was present in 60% of cases and hemoperitoneum in 50%. 96% of cases were tubal pregnancy with most of them tubal rupture. In 98% of cases, radical surgery was done. Salpingectomy was the most common surgery done (90%). There was no negative laparotomy in this study. There was no maternal mortality in this series. In all the 100 cases of ectopic pregnancy studied, the ultrasonography provided definitive diagnosis resulting in 100% sensitivity and 100% specificity, predictive value of positive test being 100%. Ultrasonography done in earlier weeks of gestation had sensitivity of 96% and false negative 4%.