Sonographic evaluation for ectopic pregnancy: transabdominal scanning of patients with nondistended urinary bladders as a complement to transvaginal sonography.

Abstract

T he sonographic evaluation for cctopic pregnancy initially depended on observations from the transabdominal perspective. With the advent of transvaginal techniques, however, the necessity for transabdominal scanning has been called into question. The transvaginal approach increases sensitivity and specificity for both identifying cctopic pregnancy and diagnosing early intrauterinc pregnancy [1-4], and this technique can be performed with greater speed and convenience because it does not require the patient to have a full urinary bladder. Consequently, transabdominal sonography has been supplanted by transvaginal scanning in a growing number of practices, in which transvaginal scanning alone is performed to evaluate for ectopic pregnancy [5-7]. Despite the central role of tnsnsvaginal scanning, numerous cases in which crucial findings were appreciated only from the transabdominal perspective have been documented [1-4, 8, 9]. The dilemma is that transabdominal scanning through a full bladder causes an inevitable delay while the bladder fills or a Foley catheter is introduced, but a transabdominal scan provides a more comprehensive view of the pelvis, one that may be cmcial for accurate diagnosis, particularly in patients with abnormalities that are large or beyond the range of the transvaginal transducer. This article describes a compromise solution in which an abdominal scan is obtained for patients with an empty or incompletely distended bladder as a prelude to transvaginal examination. This approach provides an expeditious means of detecting the sonographic manifestations of cctopic pregnancy that are at greatest risk to be missed with transvaginal scanning.