Detection Of Ectopic Pregnancy Research Articles

Relationship of Beta-Human Chorionic Gonadotropin to Ectopic Pregnancy Detection and Size.

Ectopic pregnancies are a significant cause of morbidity and mortality in the first trimester of pregnancy. Hospital protocols requiring a specific beta-human chorionic gonadotropin (β-hCG) level to qualify for diagnostic testing (pelvic ultrasound) can delay diagnosis and treatment. In this study we sought to determine the relationship between β-hCG level and the size of ectopic pregnancy with associated outcomes. We performed a retrospective case review of patients diagnosed with ectopic pregnancy in an urban, academic emergency department specializing in obstetrical care, from January 1, 2015-December 31, 2017. Variables extracted included presentation, treatment, adverse outcomes, and rates of rupture. We identified 519 unique ectopic pregnancies. Of those ectopic pregnancies, 22.9% presented with evidence of rupture on ultrasound, and 14.4% showed evidence of hemodynamic instability (pulse >100 beats per minute; systolic blood pressure <90 millimeters of mercury; or evidence of significant blood loss) on presentation. Medical management outcomes were as follows: of 177 patients who received single-dose methotrexate, 14.7% failed medical management and required surgical intervention; of 46 who received multi-dose methotrexate, 36.9% failed medical management and required surgical intervention. Ultimately, 55.7% of patients required operative management of their ectopic pregnancy. Mean β-hCG level at initial presentation was 7,096 milli-international units per milliliter (mIU/mL) (SD 88,872 mIU/mL) with a median of 1,289 mIU/mL; 50.4% of ectopic pregnancies presented with β-hCG levels less than the standard discriminatory zone of 1,500 mIU/mL. Additionally, 44% of the patients who presented with evidence of rupture had β-hCG levels less than 1,500 mIU/mL. Comparison of size of ectopic pregnancy (based on maximum dimension in millimeters) to β-hCG levels revealed a very weak correlation (r = 0.144, P < .001), and detection of ectopic pregnancies by ultrasound was independent of β-hCG levels. Levels of β-hCG do not correlate with the presence or size of an ectopic pregnancy, indicating need for diagnostic imaging regardless of β-hCG level in patients with clinical suspicion for ectopic pregnancy. Almost one-sixth of patients presented with evidence of hemodynamic instability, and approximately one quarter of patients presented with evidence of rupture requiring emergent operative management. Ultimately, more than half of patients required an operative procedure to definitively manage their ectopic pregnancy.

Diagnostic Accuracy of Doppler Ultrasound in Ectopic Pregnancy

Objective: To evaluate the diagnostic accuracy of Doppler ultrasound in the detection of ectopic pregnancy. Methodology: This prospective observational study was conducted at PESSI Hospital, I-12, Islamabad, in collaboration with different hospitals for data collection. The study was carried out over a period of one year from October 2021 to September 2022. All pregnant women aged &gt;17 years presenting with symptoms of ectopic pregnancy, regardless of parity, were included. All patients underwent color Doppler ultrasound using a dedicated machine. Subsequently, the patients were followed until they underwent surgical management, and the operative findings were meticulously recorded. Data were collected using a pre-designed proforma and analyzed with SPSS version 20. Results: The mean age of the participants was 31.53 years, and the average gestational age was 6.03 weeks. 35.0% of the participants had a positive family history. According to color Doppler ultrasound findings, the majority of cases (96.7%) were identified as positive for ectopic pregnancy, while surgical findings confirmed ectopic pregnancy in 93.3% of cases. The sensitivity of color Doppler ultrasound was 100%, specificity was 60%. The positive predictive value (PPV) was 94% and negative predictive value (NPV) was 100%, suggesting that it was 100% accurate in ruling out ectopic pregnancy. Conclusion: Color Doppler ultrasound was found to be a highly sensitive, reliable, and noninvasive tool in diagnosing ectopic pregnancy. However, the findings cannot be definitively applied due to limitations, particularly the small sample size. Further large-scale studies are strongly recommended for validation and confirmation of the findings.

Detection of ectopic pregnancy and serum beta hCG levels in women undergoing very early medical abortion: a retrospective cohort study

Objective To evaluate the outcome of the very early medical abortion (VEMA) protocol and whether it could increase early diagnosis and treatment of an asymptomatic ectopic pregnancy (EP). To investigate serum β-hCG levels correlated to ultrasound findings, and decline in β-hCG after successful VEMA. Study design A retrospective case-note review. The population consisted of all women undergoing a VEMA during 2004–14 in Austria and 2012–13 in Sweden. Two cohorts identified based on sonography findings; 106 women with an empty uterine cavity were classified as a pregnancy of unknown location (PUL) and 576 women with an intrauterine sac-like structure without a yolk sac or foetal structure were classified as probable intrauterine pregnancy (probable IUP). Results Overall, 660 women (97.6%) had a successful VEMA, 94/101 women (93.1%) in the PUL group and 566/575 women (98.4%) in the probable IUP group (p < 0.001). We identified six asymptomatic EP (0.88%). A gestational sac (< 10 mm) was detected at a median/range β-hCG level 2728 (1600–4497) IU/l. The mean decline in β-hCG was 93%, (95% CI 91.7–94.2) 5–10 days after successful abortion. Conclusions VEMA may be of particular clinical benefit for women. Apart from offering a possibility to start an abortion without delay as soon as the woman has sought abortion care, it may also offer an opportunity to detect and treat EP at an early gestational age. However, the rate of EP was very low.

Sonographic Evaluation of Ectopic Pregnancies

This study was carried out in the Radiology Department, District Head Quarter Teaching Hospital (D.H. Qr) and Dera X-Rays / Ultrasound Clinic. Dera Ismail Khan, NWFP, by performing abdominal and pelvic ultrasonography of all the suspected patients and endo-vaginal of selected cases by comparing with other modalities used for the diagnosis of pregnancy especially the ectopic. Eighty-five percent cases of ectopic pregnancies were diagnosed by abdominal / pelvic ultrasonography, while this ratio was increased up to 95% by endo-vaginal ultrasonography in those cases where the abdominal sonography was not helpful for accurate diagnosis. The study concluded that increased availability of ultrasonography leads to improve quality in the detection of ectopic pregnancy. It is necessary to screen all the patients with first trimester cramping and bleeding by ultrasonography.

61 Characteristics of Ectopic Pregnancies Presenting to an Urban Academic Emergency Department at a Tertiary Care Center for Obstetrics

To identify the clinical utility of Beta Human Chorionic Gonadotropin levels and the overall rate of medical treatment failure, hemodynamic instability, and emergent surgery for ectopic pregnancies in the ED. An interim analysis of a retrospective case review of patients seen in an urban academic Emergency Department specializing in obstetrical care from January 1, 2015 to December 31, 2017 with the diagnosis of ectopic pregnancy. Data from the chart was extracted for multiple variables including presentation, treatment, adverse outcomes and rates of rupture. In this cohort, 367 unique ectopic pregnancies were identified. 23.7% of these patients initially presented with evidence of rupture on pelvic ultrasound. Additionally, 16.2% showed evidence of hemodynamic instability (Heart rate>100, SBP<90 or evidence of significant blood loss). 18.5% (n-113) of patients who received single-dose methotrexate failed medical management and required surgical intervention. For patients who received multi-dose methotrexate, 45.1% (n-29) failed medical management. Ultimately, 53.4% of patients required operative management of their ectopic pregnancy. Although the mean Beta Human Chorionic Gonadotropin (ß-HCG) level at initial presentation was 6515 mlU/ml (SD 16291 mlU/ml) with a median of 1274 mlU/ml, 51.7% of ectopic pregnancies presented with ß-HCG levels less than the standard discriminatory zone of 1500 mlU/ml. Additionally, 40% of the patients who presented with evidence of ectopic rupture had ß-HCG levels less than 1500mlU/ml. When comparing the size of the ectopic pregnancy (based on maximum dimension) to ß-HCG levels, this comparison failed to show any correlation between the size of the ectopic pregnancy and the ß-HCG level. Furthermore, detection of ectopic pregnancies by ultrasound was also independent of ß-HCG levels. ß-HCG levels do not correlate with the presence or size of an ectopic pregnancy. This further supports the need to perform appropriate diagnostic imaging regardless of ß-HCG level in patients with suspicion for ectopic pregnancy. Almost a fifth of patients present with evidence of hemodynamic instability, and approximately one quarter of patients presented with a ruptured ectopic pregnancy requiring emergent operative management. Close follow-up is essential for medically treated ectopic pregnancies as many patients will require surgical intervention for definitive management. Ultimately, more than 50% of patients still require an operative procedure to definitively manage their ectopic pregnancy.

Gasless laparoendoscopic single-site surgery with intraoperative autologous blood transfusion for management of ectopic pregnancy with significant hemoperitoneum: a retrospective observational study

BackgroundWith advances in diagnostic and therapeutic modalities, earlier detection of ectopic pregnancy with minimal symptoms makes laparoscopic management more common. However, if diagnostic delay occurs, significant hemoperitoneum associated with ectopic pregnancy is still a potentially life-threatening condition, which presents a therapeutic challenge especially when minimally invasive surgical approach is a significant concern. Herein, retrospective observational study in 18 consecutive cases of ectopic pregnancy with significant hemoperitoneum ≥ 800 mL was performed to assess the feasibility and efficacy of gasless laparoendoscopic single-site (LESS) surgery with intraoperative autologous blood cell salvage and donation for management.ResultsAt triage, median shock index was 0.95, median hemoglobin value was 6.5 g/dL, and median serum β-hCG value was 13,651 U/L. Surgical diagnosis included 7 ampullary (including 5 abortions and 2 ruptures), 5 ruptured isthmic (including 1 heterotopic pregnancy in remnant tube after salpingectomy and 1 remnant tube pregnancy after salpingo-oophorectomy), 4 ruptured interstitial (including 1 case after salpingectomy), and 2 ruptured ovarian pregnancies. Among these cases, 16 cases were successfully managed by LESS surgery, while, in 2 cases with interstitial pregnancy, conversion to multi-port laparoscopic surgery along with transfusion of bank blood were required. Laparotomic conversion was not experienced. Surgical procedures in 16 cases successfully completed by LESS surgery with intraoperative autologous blood transfusion included unilateral salpingectomy for 7 ampullary and 5 isthmic pregnancies, cornuotomy and cornual resection for each 1 case with interstitial pregnancy, and unilateral salpingo-oophorectomy and partial ovarian resection for each 1 case with ovarian pregnancy. Median surgical duration was 57.5 min, median amounts of salvaged peritoneal blood were 950 mL (range 800–2000 mL), and median amounts of transfused autologous blood were 540 mL (range 450–1300 mL). Major complications associated with LESS surgery and intraoperative autologous blood transfusion were not experienced.ConclusionGasless LESS surgery with intraoperative autologous blood transfusion is a feasible minimally invasive surgical option with avoidance to use homologous blood for management of selected cases of ectopic pregnancy even with significant hemoperitoneum.

Role of transabdominal ultrasound in detection of ectopic pregnancy

Background &amp; Objectives: Ectopic pregnancy is one of the common medical emergencies encountered in the clinical practice. Confirmation of diagnosis is usually done by urine pregnancy test and transabdominal sonography. Thus, the present study is carried out to determine the role of transabdominal ultrasonography in the diagnosis of ectopic pregnancy by comparing the ultrasonography findings with that of operative and histopathology and to evaluate clinical profile of the women with confirmed ectopic pregnancy. Materials &amp; Methods: Transabdominal ultrasound record of patients referred for first trimester ultrasound, from January 2008 to December 2015, at radiology department of Kist medial college teaching hospital were reviewed to identify patients with ectopic pregnancy. Among these patients those who underwent surgery and histopathology confirmed ectopic pregnancies were identified and their medical records were retrieved. Ultrasound and clinical profile were recorded and statistically analyzed. Results: There were 19 patients with ultrasound diagnosis of ectopic pregnancy among 1480 first trimester ultrasound record. Among these patients, ectopic pregnancy was confirmed on 18 patients. Ultrasound diagnosis included adnexal mass with pelvic fluid in 15 (83.3%) patients and pelvic fluid without adnexal mass in 4 (16.7%) patients. The study result revealed that sensitivity of transabdominal ultrasonography was 100% and specificity was 99.9%. Positive predictive value and negative predictive value of transabdominal ultrasonography was 94% and 100%.Conclusion: The transabdominal ultrasound accurately diagnose ruptured ectopic pregnancy.JCMS Nepal. 2016;12(1):1-4.

Spontaneous Unilateral Tubal Twin Ectopic Pregnancy: A Case-Based Discussion and Assessment

ABSTRACT Introduction Two percent of all 1st trimester pregnancies in the United States are ectopic. Transvaginal ultrasound is considered the mainstay in diagnosis. Color Doppler ultrasound can prove to be an added helpful modality in identifying ectopic pregnancies. Case report An 18-year-old nulliparous female presented with vaginal bleeding and lower abdominal pain. Pelvic exam revealed tenderness in the right adnexal region with elevated quantitative serum beta-hCG. A transvaginal ultrasound showed an echogenic ring adjacent to the right ovary and M-mode and color Doppler revealed two fetal heart tones. Color Doppler enabled visualization of randomly dispersed tubal arteries and heart activity of both embryos. A right salpingectomy was performed without complications and beta hCG levels returned to undetectable levels. Conclusion B mode ultrasound is a vital diagnostic tool in the detection of ectopic pregnancy. Color Doppler provides both morphologic and functional information essential for determining the optimal therapeutic strategy. Three-dimensional ultrasound with color and/or power Doppler has proven useful in both the initial diagnosis and follow-up of ectopic pregnancies especially in patients following assisted reproduction treatment.

Abstracts: ASUM Annual Scientific Congress 2011

Abstracts: ASUM Annual Scientific Congress 2011

HCG as a patient

hCG as a patient

Incidental Detection of Interstitial Pregnancy on CT Imaging

Ectopic pregnancy is a potentially life-threatening condition. Detection of ectopic pregnancy on CT images is rare. In this case, we describe the CT findings of interstitial pregnancy both before and after rupture. If CT images demonstrate the presence of a strong enhancing ring-like mass in the pelvis, ectopic pregnancy should be considered.

The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy

To determine the effectiveness of an initial transvaginal ultrasound scan (TVS) in the detection of ectopic pregnancy in consecutive women attending an early pregnancy unit (EPU). This was a prospective observational study. Unselected women attending a dedicated EPU underwent a TVS. Women were classified as having an intrauterine pregnancy (IUP), ectopic pregnancy or pregnancy of unknown location (PUL). Women with a PUL were followed up until the final location of the pregnancy was determined. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) with 95% confidence intervals (CIs) for the initial TVS in the diagnosis of ectopic pregnancy were calculated. During a one-year study period, 5318 consecutive women attended the EPU. Outcome data were available for 5240 (98.5%) women. Of these, the initial TVS showed an IUP in 4693 (89.6%) cases and an ectopic pregnancy in 91 (1.7%) cases. The remaining 456 (8.7%) women were classified as PUL, and of these 31 (6.8%) were subsequently found to have ectopic pregnancies. The overall sensitivity of the initial TVS in the diagnosis of ectopic pregnancy was 73.9% (95% CI: 65.1-81.6) with a specificity of 99.9% (95% CI: 99.8-100), a PPV of 96.7% (95% CI: 90.7-99.3) and an NPV of 99.4% (95% CI: 99.2-99.6). In unselected women attending an EPU, pregnancy location can be diagnosed accurately in over 90% of all pregnancies and in 73.9% of ectopic pregnancies with a single TVS.

Pregnancies of unknown location: consensus statement

The rate of PULs in different studies ranges from 8 to 31%1-10. The prevalence of PULs is determined by the quality of ultrasound scanning11. The higher the quality of scanning, the better the detection of ectopic pregnancy using ultrasound as a single diagnostic test, which in turn results in fewer women being classified with a PUL. Up to 90% of clinically relevant ectopic pregnancies can be detected at the initial ultrasound scan12-14. The panel believes that most modern units using TVS should maintain PUL rates below 15%. Most PULs are not aggressive and represent either failing intrauterine or ectopic pregnancies which are never visualized using TVS (failing PULs) or intrauterine pregnancies too early to visualize using TVS. Clinically stable women with a PUL should initially be managed expectantly, as expectant management of women with a PUL is safe1-7, 15. There is no consensus about appropriate intervention rates in women with a PUL. Clinical audit should be regularly performed to determine the rate of emergency surgery because of undetected ectopic pregnancies and the rate of unnecessary intervention (negative laparoscopy). The initial serum human chorionic gonadotropin (hCG) level is not predictive of PUL outcome11, 16. The change in serum hCG over time or the hCG ratio (hCG at 48 h/hCG at 0 h) can be used to define failing PULs16, 17. Initial serum progesterone levels <20 nmol/L or a 48-h hCG ratio <0.87, i.e. a serum hCG fall >13% over 48 h, identify those PULs which resolve spontaneously and do not require intervention4, 16. Further studies are required to compare the hCG ratio to serum progesterone as markers of pregnancy failure. Serum progesterone measurements are not reliable in the diagnosis of ectopic pregnancy18. According to a meta-analysis, serum progesterone measurement can identify women at risk for ectopic pregnancy, but its discriminative capacity is insufficient to diagnose ectopic pregnancy with certainty19. Mathematical models based on the hCG ratio20, 21 have been developed to predict PUL outcome. These need to be tested prospectively in multicenter trials in order to evaluate their diagnostic performance in different populations. In most cases, uterine curettage should not play a role in the classification of PULs. It does not accurately differentiate between intra- and extrauterine pregnancies and may lead to inadvertent termination of a viable pregnancy22. A single-visit approach to the management of PULs is not appropriate, because it may result in an unacceptably large proportion of clinically significant ectopic pregnancies being missed23. The optimal clinical management of women with PULs involves reducing the number of visits without compromising the outcome of these pregnancies. In conclusion, consensus can be achieved in both the diagnostic approach and management of women with PULs. The panel agreed that because most PULs are at low risk of being an ectopic pregnancy, provided that the ultrasound examiner is sufficiently skilled and uses an ultrasound system with acceptable image quality, future efforts should concentrate on minimizing follow-up.

The early diagnosis of ectopic pregnancy

In a survey of 235 consecutive cases of ectopic pregnancy it was found that over 50 per cent were incorrectly diagnosed by the general practitioner and 36 per cent by a hospital doctor. Ten per cent of patients were sent home before the diagnosis was made. Over 30 per cent of patients were sent to general surgical wards and these patients had different characteristics from those sent to gynaecological wards. High risk patients can be identified from their past history. The increasing use of the laparoscope has been associated with earlier detection of ectopic pregnancy before the stage of rupture.

Which Ectopic Pregnancy Treatment Is Best for Preserving Fertility

Sensitive pregnancy tests and ultrasounds allow early detection of ectopic pregnancies, enabling clinicians to use treatment techniques that may

Ultrasound availability in the evaluation of ectopic pregnancy in the ED: Comparison of quality and cost-effectiveness with different approaches

The liberal use of ultrasonography has been advocated in patients with first trimester cramping or bleeding to avoid misdiagnosis of ectopic pregnancy in the emergency department (ED). The cost-effectiveness of different approaches to ultrasound availability has not been previously reported. In this study, we investigated measures of quality and cost-effectiveness in detecting ectopic pregnancy in the ED over a 6-year period, divided into three approximately equal epochs with three distinct approaches to ultrasound availability. The study retrospectively identified 120 cases of ectopic pregnancy seen in the ED over 6 years. There was significant improvement in the percentage of patients with ectopic pregnancy who were documented to have absence of intrauterine pregnancy (IUP) at the first visit from 76% during Epoch 1, when there was limited availability of ultrasound through medical imaging (MI Sono), to 88% in Epoch 2, when MI Sono was readily available, to 96% in Epoch 3, when both MI Sono and ultrasound by emergency physicians (ED Sono) were readily available ( P = .02). The estimated number of MI Sonos ordered by emergency physicians in patients at risk for ectopic pregnancy increased from 5.2 per ectopic pregnancy in Epoch 1 to 11.8 per ectopic pregnancy in Epoch 2, and declined to 5.5 per ectopic pregnancy in Epoch 3, when 19.9 ED Sonos per ectopic pregnancy were also done. The cost of ED Sono in Epoch 3 was more than offset by savings from avoiding calling in ultrasound technicians after regular medical imaging department hours. The specificity of ED Sono in ruling in an IUP was 100% (95% CI 98.3 to 100%), but analysis of secondary quality indicators reflecting times from first ED visit to treatment in Epoch 3 raised the possibility that an adnexal mass or signs of tubal rupture may have been missed on some ED Sonos. We conclude that increased availability of ultrasonography leads to improved quality in the detection of ectopic pregnancy in the ED, but at the expense of a disproportionate increase in the number of ultrasound studies done per ectopic pregnancy detected. Our study suggests that the most cost-effective strategy is for emergency physicians to screen all patients with first trimester cramping and bleeding with ED Sonos, and to obtain MI Sonos at the time of the initial ED visit in all cases in which the ED Sono is indeterminate or shows no IUP. (Am J Emerg Med 2000;18:408-417.

Dopplerdiagnostik der ektopen Schwangerschaft. Ein diagnostischer Zugewinn?

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.

The role of transvaginal ultrasonography and colour Doppler imaging in the detection of ectopic pregnancy.

To assess the use of transvaginal ultrasound and colour Doppler imaging in the detection of ectopic pregnancy. Seventy-one patients with suspected ectopic pregnancies had transvaginal sonography and colour Doppler imaging performed and 61 ectopic pregnancies were confirmed at surgery. Various ultrasound features on transvaginal B mode scanning were noted and the resistance index of peritrophoblastic flow in the adnexal masses computed. The use of transvaginal B mode imaging alone in the diagnosis of ectopic pregnancy achieved a sensitivity of 98% and a positive predictive value of 86%. The mean gestational age at time of diagnosis was 6 weeks 5 days (range 4 weeks to 13 weeks 2 days). The use of transvaginal colour flow imaging did not increase detection rates of ectopic pregnancy. The mean RI values for patients with or without ectopic pregnancy were almost identical. Colour Doppler imaging failed to improve on the results of transvaginal B mode sonography in the detection of ectopic pregnancy.

Vaginal Sonography and a Positive Serum hCG Test for Early Detection of Ectopic Pregnancy

SummarySummaryA transvaginal scan was performed on 53 women with suspected ectopic pregnancy and a positive serum hCG. In 22 patients, ectopic pregnancy was correctly ruled out, and the diagnosis of ectopic pregnancy was proved at laparotomy in 30 patients. Only one false positive diagnosis was made. The sensitivity of diagnosis of ectopic pregnancy with transvaginal ultrasound was 100 per cent and the specificity was 96 per cent. The positive and negative predictive values of this approach were 97 and 100 per cent respectively. Laparoscopy was avoided in 12 patients (51 per cent) with early intra-uterine pregnancies and corpus luteum cyst complications. The addition of transvaginal ultrasound scan as an aid in the management of ectopic pregnancy gives improved accuracy of pre-operative diagnosis, reduces the number of unnecessary laparoscopies and allows the potential for use of non-surgical methods of treatment.

Early detection of ectopic pregnancy by transvaginal ultrasound

Transvaginal (TVU; 19 patients) and transabdominal ultrasound (TAU; 24 patients) were compared in their ability to visualize an ectopic pregnancy. The direct visualization of ectopic pregnancy (EUP) was 25% with TAU and 94.7% with TVU. All women had a proven EUP in laparoscopy. TAU approach showed a significant inferiority (P less than 0.02) and TVU a superiority (P less than 0.08) in comparison to clinical examination. 83% of 43 women had spotting. Nonspecific signs for EUP like fluid in the pouch of Douglas was seen in 20.9%. Thin endometrium was seen in 6.9%, in 37.2% the thickness of endometrium was under 10 mm, in 55.8% more than 10 mm. An intrauterine pseudogestation sac was detected in 6.9%, corpus luteum formation in 37.2%.