Transvaginal Sonography In Diagnosis Research Articles

Diagnosis of endometrial hyperplasia in routine gynecological practice

Мета роботи. Визначити діагностичну точність, чутливість, специфічність, позитивне та негативне прогностичні значення ультразвукової діагностики гіперплазії ендометрія за допомогою порівняння результатів трансвагінального ультразвукового дослідження з патогістологічним висновком. Матеріали та методи. Здійснили ретроспективний аналіз 156 історій хвороби пацієнток, котрим виконано гістерорезектоскопію або лікувально-діагностичне вишкрібання порожнини матки, з наступним порівнянням передопераційного діагнозу за результатами трансвагінального ультразвукового дослідження (ТвУЗД) і патогістологічного висновку. Відповідно до результатів ТвУЗД перед процедурою пацієнток поділили на 2 групи. Перша група – 71 жінка з передопераційним діагнозом гіперплазія ендометрія. У другій групі було 85 жінок, яким входження в порожнину матки виконали за іншими показаннями. За допомогою статистичних і математичних методів визначена діагностична цінність методу ТвУЗД для виявлення гіперплазії ендометрія та для патології, котра надалі потребує інвазивного втручання в порожнину матки. Результати. У першій групі збіг передопераційного діагнозу (за даними ТвУЗД) із патогістологічним висновком гіперплазія ендометрія визначили тільки у 35 жінок, тобто позитивне прогностичне значення становило тільки 49,3 %. Аналіз другої групи жінок показав, що правильний діагноз (відсутність гіперплазії ендометрія) спостерігали у 52 випадках, тобто негативне прогностичне значення дорівнювало 61,18 %. Чутливість ТвУЗД під час діагностики гіперплазії ендометрія становила тільки 51,47 % (95 % CI 39,03–63,78). Специфічність ТвУЗД під час діагностики гіперплазії ендометрія становила 59,09 % (95 % CI 48,09–69,46). Але щодо лікувальної тактики, то відсутність показань до інвазивного внутрішньоматкового втручання спостерігали в 4,22 % жінок першої групи та у 2,35 % другої групи. Висновки. ТвУЗД має низьку діагностичну цінність для встановлення точного діагнозу гіперплазія ендометрія. ТвУЗД має високу діагностичну цінність для визначення лікувальної тактики (необхідності виконання гістерорезектоскопії чи лікувально-діагностичного вишкрібання порожнини матки) при внутрішньоматковій патології. Встановили низьку діагностичну цінність ТвУЗД під час діагностики гіперплазії ендометрія, що диктує необхідність додаткового аналізу, враховуючи кваліфікацію фахівців з УЗ-діагностики, з’ясування адекватності виконання наказу МОЗ № 676, який вимагає наведення таких параметрів, як структура ендометрія, включення, звукопровідність, зовнішній контур М-ЕХО та рельєф порожнини матки, а в пацієнток у пери- і постменопаузі – визначення ендометріально-маткового співвідношення.

Performing an ultrasound to assess for DIE

Endometriosis is a common and often debilitating gynaecological disorder that affects 5–10% of women. The prevalence is even higher among women with symptoms of endometriosis which include chronic pelvic pain, acquired dysmenorrhoea, dyspareunia, dyschezia, menorrhagia, abnormal bleeding and infertility. Approximately 80% of women suffering from endometriosis will develop superficial lesions while 20% will develop deep infiltrating endometriosis (DIE). The removal of deep infiltrating endometriosis is significantly more complex, particularly when pouch of Douglas obliteration or bowel nodules are present. The surgery can usually not be completed unless DIE was diagnosed preoperatively. The technique to diagnose deep infiltrating endometriosis with transvaginal ultrasound (TVUS) was first described in detail in 2009. Since then, the accuracy of TVUS for the prediction of DIE has been well established in the literature. Transvaginal ultrasound is widely used as a first line of investigation for women with gynaecological symptoms. Because endometriosis is a very common cause of gynaecological symptoms in women of the reproductive age group, including the assessment for DIE in the routine pelvic ultrasound allows earlier diagnosis and better surgical outcomes for all women with deep infiltrating endometriosis. This presentation describes in detail the different steps required to obtain a transvaginal ultrasound diagnosis of deep infiltrating endometriosis.

How to measure size of tubal ectopic pregnancy on ultrasound.

To identify the preoperative ultrasound parameters for assessing the size of tubal ectopic pregnancy that correlate best with findings at surgery. This was a prospective study of all women attending our center who had a conclusive transvaginal ultrasound diagnosis of tubal ectopic pregnancy over a 10-month period. In each case, the total size of the ectopic pregnancy was measured by placing the calipers on the outer edges of the visible trophoblastic tissue. In ectopic pregnancies presenting with a well-defined gestational sac, the size of the celomic (chorionic) cavity was also measured using the inner borders of the trophoblastic ring as reference points. In women with signs of intra-abdominal bleeding, the size of the hematosalpinx and/or hemoperitoneum was measured. Surgeons were blinded to the ultrasound measurements and were asked to estimate the size of the ectopic pregnancy and the amount of hemoperitoneum intraoperatively. A total of 105 women were diagnosed with a tubal ectopic pregnancy on ultrasound examination, of whom 71 (67.6%) were managed surgically. A significant (P < 0.01) positive correlation was found between all ultrasound measurements and the size of the tubal ectopic pregnancy as reported during surgery. In the absence of hematosalpinx, the mean total outer diameter of the ectopic pregnancy had the highest positive correlation with the size of the tubal ectopic pregnancy at surgery (r = 0.65, P < 0.001). In cases complicated by hematosalpinx, the mean diameter of the tube was the only variable that correlated significantly with the estimated size of the ectopic pregnancy at surgery (P < 0.001). There was a significant positive association between the amount of hemoperitoneum on ultrasound and the estimated volume of intraperitoneal blood at surgery (P < 0.001). The mean size of a hematosalpinx and the total outer mean diameter of an ectopic pregnancy on ultrasound correlate better with the surgical findings than does the size of the celomic cavity. Our findings show that the standard approach of measuring the size of an intrauterine pregnancy on ultrasound should be adapted to include these additional measurements in women diagnosed with a tubal ectopic pregnancy. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Subcutaneous Progesterone for Endometrial Polyps in Premenopausal Women: A Preliminary Retrospective Analysis

Study ObjectiveTo investigate the effects of 3 cycles of subcutaneous progesterone administered during the luteal phase on the regression rate of symptomatic and asymptomatic endometrial polyps in premenopausal woman. DesignA retrospective study (Canadian Task Force classification II-2). SettingA department of obstetrics and gynecology in a university hospital. PatientsOne hundred twenty-seven reproductive-aged women presented with endometrial polyps from January to December 2016. InterventionsA retrospective comparison of patients treated with subcutaneous progesterone and those managed by the “wait and see” approach. Measurements and Main ResultsPatients were divided into 2 groups: the group treated with subcutaneous progesterone (cases) and the wait and see group (controls). Women in the treatment group were administered 25 mg subcutaneous progesterone during the luteal phase for 7 days for 3 months. The wait and see group included patients refusing progesterone therapy who were reevaluated 3 menstrual cycles after the transvaginal sonographic diagnosis. Both the treatment group (n = 61) and the wait and see group (n = 32) were evaluated with a follow-up ultrasound examination after 3 months. The regression rate of endometrial polyps in women treated with subcutaneous progesterone was compared with the wait and see patients. The regression in the number and/or dimensions of the polyps was greater in the treatment group than the control group. The regression rate was 47.5% and 12.5%, respectively (p < .001). ConclusionProgesterone appears to be a valid therapeutic alternative for the management of endometrial polyps. A prospective, randomized study is ongoing at our institution to further validate these findings.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery Myomectomy: A Novel Route for Uterine Myoma Removal

Study ObjectiveTransvaginal surgery is the most minimally invasive surgery for a gynecologic procedure, but it has the limitation of lack of exposure and limited surgical space when using traditional vaginal surgical instrumentation, such as in a hysterectomy for a uterus without descent or for a myomectomy. Transvaginal natural orifice transluminal endoscopic surgery (NOTES) offers similar benefits of traditional vaginal surgery but also expands the horizon of transvaginal surgery by allowing the surgeon to perform procedures that are typically limited to an abdominal approach. The advantages of NOTES may include no incisional pain as well as a better cosmetic outcome. These benefits help outweigh the obstacle of learning this novel approach. Our objective is to demonstrate the transvaginal NOTES technique as a combination of traditional vaginal surgical skill with single-site surgical skill. DesignStepwise demonstration of the transvaginal NOTES technique for myomectomy with narrated video footage (Canadian Task Force classification III). SettingAcademic tertiary care hospital. PatientA 42-year-old woman. InterventionsTransvaginal NOTES myomectomy with combined transvaginal surgical and single-site surgical skills. Measurements and Main ResultsA 42-year-old woman (gravida 2 para 2) with a preoperative transvaginal ultrasound diagnosis of a 6-cm left anterior myoma requested myoma removal with uterine preservation. She presented with a 2-year history of left pelvic pain and menorrhagia. The myoma was removed with minimal blood loss, and pathology revealed a necrotic myoma. The patient had resolution of her left-sided pelvic pain. ConclusionsCombined with traditional transvaginal anterior colpotomy, single-site surgical skills allow the surgeon to access the entire abdomen and perform myomectomy through a transvaginal single port. Transvaginal NOTES myomectomy is not only possible but allows myomectomy to be performed with no abdominal incision.

Hiperplasia endometrial y criterios ecográficos: reporte de caso y revisión de la literatura

The aim of this article is to review the sonographic criteria of endometrial hyperplasia and define the cutoff value to indicate the completion of the endometrial biopsy due to its relationship with the risk of endometrial carcinoma. We report the case of a woman aged 47 with four years of vaginal bleeding characterized by menorrhagia, metrorrhagia, and hypermenorrhea being treated with oral contraceptives without improvement, and transvaginal ultrasound diagnosis of endometrial hyperplasia. For the diagnosis of endometrial pathology in postmenopausal women with vaginal bleeding, the authors recommend a cutoff value of endometrial thickness by transvaginal ultrasound of 4-5 mm with sensitivity of 98% and negative predictive value of 99% since higher values are closely related to endometrial carcinoma.

Efficacy of Three-Dimensional Transvaginal Sonography in Diagnosis of Uterine Cavity Abnormalities Among Infertile Women: A Cross-Sectional Study

Objectives: To evaluate the efficacy of three-dimensional transvaginal sonography (3D-TVS) in diagnosis of uterine cavity abnormalities among infertile women. Methods: This was a cross-sectional study at Royan Institute, Tehran, from April 2012 and March 2013. All infertile women who were booked for hysteroscopy during this period of time were recruited in the study. Patients underwent preoperative 3D-TVS by an expert radiologist and hysteroscopy was performed by an expert surgeon. Patients history, 3D-TVS findings and hysteroscopy results were assessed to collect data. Agreement between sonography findings and hysteroscopy results, sensitivity, specificity, positive and negative predictive values, and efficacy of 3D-TVS in diagnosis of congenital and acquired uterine disorders were calculated by SPSS18 software using Cross-tabs, Kappa test, and other statistic analysis. Results: Totally, 153 women were recruited in the investigation. Patients aged 30.78 4.79 years in average and the duration of infertility was 4.2 2.91 years among them. Uterine abnormalities were grouped as congenital and acquired. Overall efficacy of 3D TVS in diagnosis of uterine disorders was calculated 92.8% with Kappa value of 82.3, indicating a good agreement between ultrasound findings and hysteroscopy results. Efficacy of 3D TVS in diagnosis of congenital and acquired uterine lesions was calculated 92.1% and 87.6% respectively. Conclusions: Our study demonstrated that 3D TVS has a good efficacy and reliable agreement with hysteroscopy in diagnosis of uterine lesions among infertile women. Therefore, it can decrease the number of diagnostic hysteroscopies.

Combined transvaginal and abdominal ultrasound in the diagnosis of early ectopic pregnancy

Objective To observe the accuracy of abdominal ultrasound combined with transvaginal ultrasound in the early diagnosis of ectopic pregnancy, thus to provide reference for clinical diagnosis of ectopic pregnancy. Methods The clinical data of 68 patients, who pathologically confirmed or conservative treatment with clinical diagnosis of ectopic pregnancy, were retrospectively analyzed.All patients were treated with abdominal ultrasound, vaginal ultrasound examination.The accuracy and missed ectopic pregnancy rate of transvaginal ultrasound and abdominal B ultrasound and joint inspection were observed.And the presence or absence of abnormal ovarian uterus were recorded. Results By comparison with pathological diagnosis, joint diagnosis of 32 cases of ectopic pregnancy, the diagnosis rate was 94.1%, missed 2cases, accounted for 5.9%; Transvaginal ultrasound diagnosis were 26 cases, accounted for 76.5%, missed by 8 cases, accounted for 23.5%; Abdominal ultrasound diagnosis were 24 cases, accounted for 70.6%, missed 10 cases, accounted for 29.4%.Joint inspection diagnosis rate was significantly higher than abdominal or vaginal ultrasound(χ2=16.75, 14.38, all P 0.05).Transvaginal ultrasound detected primitive heart tube pulse, mass, blood flow and gestational sac-like structures within the mass were significantly higher than the probability of abdominal ultrasound(χ2=26.71, 7.18, 10.25, 50.28, 25.69, 6.39, all P<0.05). Conclusion United abdominal ultrasound and transvaginal ultrasound can significantly improve the early detection rate of ectopic pregnancy, which can provide reference for clinical diagnosis and treatment. Key words: Pregnancy, ectopic; Ultrasonography; Diagnosis

Poliquistosis ovárica: hallazgos clínicos y hormonales

Objetivo: Evaluar los hallazgos clínicos y hormonales relacionados con la poliquistosis ovárica. Diseño: Estudio retrospectivo. Lugar: Servicio de Ginecología e Infertilidad del Hospital Arzobispo Loayza. Material y Métodos: Se determinó el perfil hormonal de 69 pacientes en edad reproductiva con diagnóstico de ovarios poliquísticos por ecografía transvaginal. Resultados: Se encontró oligoamenorrea en 67,7%, infertilidad en 28,8%, hirsutismo en 23,7% e índice de masa corporal &gt; 25 en 42,4%. El LH estuvo elevado en 47,1 %, con relación LH/FSH &gt; 2 en 24,5% y testosterona elevada en 20,9 %. Se observó que 64,3% de las mujeres obesas presentaban oligoamenorrea, 42,8% hirsutismo, 50% infertilidad y 50% elevación de LH. Conclusión: Se observó una correlación hormonal y clínica con la presencia de obesidad, en pacientes con poliquistosis ovárica.

Manejo laparoscópico de embarazo ectópico en cicatriz uterina por cesárea previa: reporte de un caso

El embarazo ectópico es la gestación que se anida fuera del endometrio que recubre la cavidad uterina. Se estima una incidencia de 0,94 a 2,6% de todas las gestaciones. Su localización en cicatriz uterina de cesárea previa (0,15%) –una rara presentación de esta patología- representa 6,15% de los casos de embarazo ectópico que ocurren en mujeres con antecedente de cesárea. En el presente artículo se analiza el caso de una paciente de 28 años, gesta 5, para 0412, con antecedente de 3 cesáreas, que acudió al Hospital Nacional Docente Materno Infantil (HONADOMANI) San Bartolomé en febrero 2013 con diagnóstico de embarazo ectópico localizado en cicatriz uterina por cesárea previa, por ecografía transvaginal, y que fue resuelto exitosamente mediante manejo laparoscópico. El embarazo ectópico localizado en la zona de cicatriz uterina por cesárea previa, aunque raro, va en aumento debido al incremento de la tasa de cesáreas. La ultrasonografía transvaginal es crucial para su diagnóstico, y actualmente no existe un consenso o guía clínica que nos oriente en su manejo.

Role of transvaginal sonography in the detection of endometrial carcinoma.

Transvagival sonography is superior to transabdominal sonography in most cases of pelvic pathology. Objective of this study is to evaluate the clinical usefulness of transvaginal ultrasonography (TVS) in pre, peri and post menopausal women suspected to have endometrial carcinoma. This cross sectional study was done with 40 patients who are clinically suspected having thickened endometrium. The study was carried out January 2007 to November 2008 for a period of two years. The patients having endometrial carcinoma diagnosed by TVS was correlated with histopathological diagnosis following collection of the report from the respective cases. Of total 40 cases, 2 (5.0%) cases were endometrial carcinoma and 38 (95.0%) were negative for endometrial carcinoma respectively in TVS findings. On the other hand 3 (7.5%) cases were endometrial carcinoma and 37 (92.5%) cases were negative for endometrial carcinoma in histopathological findings. The validity of TVS in diagnosis of endometrial carcinoma were studied by calculating sensitivity, specificity, accuracy, positive predictive value and negative predictive value, which were 67 percent, 100 percent, 98 percent, 100 percent and 97 percent respectively. As the TVS findings of the present study correlated well with the histopathology findings and the validity test values were higher than observed by others, it can be concluded that TVS is sensitive and accurate modality in the evaluation of endometrial carcinoma.

Transabdominal and transvaginal ultrasonography in diagnosis of gynecological acute abdomen

Objective To study the value of transabdominal and transvaginal ultrasonography in the diagnosis of gynecological acute abdomen.Methods 241 patients with gynecological acute abdomen confirmed by surgery and admitted into our hospital from Jan.2010 to Sept.2013 were randomly assigned to a transabdominal ultrasonography group (TAS group,n=79),a transvaginal ultrasonography group(TVS group,n=81),and a combined approach group(TCA group,n=81).With the pathological results as diagnostic gold standard,the coincidence rates of the 3 groups were observed.Results The coincidence rate was 95.06％ in TCA group,85.19％ in TVS group,and 74.68％ in TAS group,with statistical differences between TCA group and TVS and TAS groups and between TVS group and TAS group (P ＜ 0.05).Conclusion TAS combined with TVS in the diagnosis of gynecological acute abdomen is highly accurate. Key words: Transabdominal ultrasonography; Transvaginal ultrasonography; Combined approach; Gynecology and obstetrics; Acute abdomen

Transvaginal sonography in diagnosis of vesicoperitoneal fistula due to deep infiltrating endometriosis as a cause of uroperitoneum

Transvaginal sonography in diagnosis of vesicoperitoneal fistula due to deep infiltrating endometriosis as a cause of uroperitoneum

Ovarian cancer: role of ultrasound in preoperative diagnosis and population screening

Ovarian cancer: role of ultrasound in preoperative diagnosis and population screening

Ectopic Pregnancy

Ectopic pregnancy (EP) continues to be the number one cause of maternal deaths in the first trimester of pregnancy. Over the past 30 years, several key developments including accurate and rapid serum human chorionic gonadotrophin assays, the introduction of high-resolution transvaginal probes and more recently tertiary hospital Early Pregnancy Units have changed the management of EPs. Early transvaginal ultrasound diagnosis of EP not only potentially decreases mortality and surgical intervention rates, but also promotes modern management options including expectant or medical management. The aim of this review is to demonstrate that transvaginal ultrasound is the new 'gold standard' diagnostic tool of choice for all forms of EP.

Study on Transvaginal Sonographic Diagnosis of Infertility of Infertility: A Comparative Outcome With Clinical Correlations

A cross sectional comparative study was doneon ran.cvaginal sonographic (TVS) findings to diagnose infertility in 110 patients attended theta t.patient department of Obstetrics and Gynaecology at Bangabandhu Sheikh Mt jib Medical University (BSMM1.1). The study was done with an object ro asses the role of traavvaginal ultra sonography as a sensitive detector for the diagnosis of poly cystic ovarian disease. endonteriomas. leontyomas.retroversion of itterus.pelvic inflammatory disease. adnegal mass or pelvic tumour. congenital abnormalities of paramesonephric (niillarion)ducts and also its association with renal abnormalities. The age of the study patients ranged from 19-40 yrs. They were grouped into three categories. Amongst them 58 cases was represented with primary infertility which is 47.27 % Mike total cases. In this study 37 patients was diagnosed by TVS as having PCOD amongst them II patients presented with oligomenorrhoea. Comparison between clinical correlation and TVS findings were done in which 15 patients clinically seemed to have with endometrioma with cyst formation which correlates 10 cases of TVS findings. TVS findings were normal in 21 patients. But they had come only with primary or secondary infertility. This study included only those patients Otiose husband's semen analysis is within normal range and no other male factor. These are the unexplained infertility.

P25.14: Three‐dimensional transvaginal ultrasound diagnosis of open spina bifida at 13 + 2 weeks of gestation with an absent intracranial translucency

P25.14: Three‐dimensional transvaginal ultrasound diagnosis of open spina bifida at 13 + 2 weeks of gestation with an absent intracranial translucency

Value of transvaginal ultrasound in assessing severity of pelvic endometriosis

The objective of this study was to examine the ability of preoperative transvaginal ultrasound (TVS) scanning to assess the severity of pelvic endometriosis. Consecutive women with clinically suspected or proven pelvic endometriosis, who were booked for laparoscopy, were invited to join the study. The severity of endometriosis was assessed preoperatively using TVS and the findings were compared with the results obtained by laparoscopy using the American Society for Reproductive Medicine (ASRM) classification. In total, 201 women had preoperative TVS and laparoscopies. Of these, no endometriosis was found at laparoscopy for 62/201 (30.8%; 95% CI, 24.8-37.5), whereas 33/201 (16.4%; 95% CI, 11.9-22.2) had minimal endometriosis, 31/201 (15.4%; 95% CI, 11.1-21.1) had mild endometriosis, 27/201 (13.4%; 95% CI, 9.4-18.8) had moderate endometriosis and 48/201 (23.9%; 95% CI, 18.5-30.2) had severe endometriosis. The sensitivity and specificity of the TVS diagnosis of severe pelvic endometriosis were 0.85 (95% CI, 0.716-0.934) and 0.98 (95% CI, 0.939-0.994), respectively, and the positive and negative likelihood ratios were 43.5 (95% CI, 14.1-134) and 0.15 (95% CI, 0.075-0.295), respectively. Overall, there was a good level of agreement between ultrasound and laparoscopy in identifying absent, minimal, mild, moderate and severe disease (quadratic weighted kappa = 0.786). The mean ASRM score difference between TVS and laparoscopy in assessing severity of endometriosis was -2.398 (95% CI, -4.685 to -0.1112) and the limits of agreement were -34.62 (95% CI, -38.54 to -30.709) to 29.83 (95% CI, 25.91-33.74). TVS is a good test for assessing the severity of pelvic endometriosis. TVS is particularly accurate in detecting severe disease, which could facilitate more effective triaging of women for appropriate surgical care.

Minimally invasive surgical management of symptomatic uterine cysts

This study aims to evaluate the feasibility of a minimally invasive access-integrated protocol for aspiration or drainage of symptomatic uterine cysts. The design of the study is a prospective cohort study. The study setting is a tertiary care referral facility and university hospital. Twenty seven women with objective evidence of uterine cysts diagnosed by ultrasonography. The patients underwent transvaginal sonographic diagnosis of uterine cysts at different sites. Cyst aspiration was performed using interventional 2D ultrasonography, hysteroscopy and/or laparoscopy. Follow-up was performed for a maximum of 1 year to assess relief of symptoms and the recurrence rate. The main outcome measures of the study are success of aspiration tool, relief of symptoms, and persistence or recurrence rates. Cervical and corporeal uterine cysts were diagnosed in 19 and eight cases respectively. The mean size of the cervical cyst was 2.9 ± 1.21 (1.8–3.7) cm, while that of the uterine cysts was 4.8 ± 1.89 (3.4–-6.1) cm. Improved health-related quality of life in the form of relief of deep dyspareunia and excessive vaginal discharge were reported in eight of 12 (66.6%) and 11/14 (78.5%) cases, respectively. Aspiration of symptomatic uterine cysts is technically feasible and achieves acceptable results. Uterine cysts may not be ignored as a potential cause of gynecologic symptoms, however, their precise pathogenesis and related co morbidities including impact on fertility should be substantiated by an adequately powered prospective randomized controlled study.

OP06.09: Conservative management of tubal ectopic pregnancy: the protocol of our early pregnancy unit

Today, serial serum hCG measurements and high-resolution transvaginal ultrasound (TVS) can provide early diagnosis of most ectopic pregnancy (EP) allowing more conservative options, like medical treatment with Methotrexate (MTX) or expectant management. We reviewed the experience of our Early Pregnancy Unit (EPU) in diagnosis and treatment of tubal EPs. We performed a review of all women who presented to our EPU in the study period with a TVS diagnosis of tubal EP. In EPU EPs are managed according to a strict protocol including a full evaluation of clinical, sonographic and biochemical (hCG) data. Surgery is performed only if: clinical presentation suggests rupture (severe pain, significant hemoperitoneum on scan, haemodynamycal instability), non-compliance or failure of conservative treatment (MTX or expectant). In all other the serum hCG ratio (hCG at 48 hrs/hCG at presentation) is determined: if > 1.0 (evolving EP) women are treated with MTX in a single-dose i.m., if < 1.0 (failing EP) women are offered expectant management with weekly serum hCG. Success was defined as an uneventful decline of the hCG to pre pregnancy levels with the primary intervention. 1,395 consecutive women underwent TVS in the EPU. 60 (4,3%) tubal EPs were diagnosed. Median age (years) was 30 (IQR 24–35), median gestational age (days) at diagnosis was 47 (IQR 40–54), median serum hCG level (IU/L) at presentation was 907 (IQR 317–2217). 25 (42%) were treated surgically from the onset, 13 (22%) were treated with MTX, 22 (36%) were managed expectantly. Two women had laparoscopy as a failure of MTX and expectant management respectively. Success rates of MTX and expectant management were 92% and 95%, respectively. Today most EPs can and should be managed non-surgically. Early diagnosis, together with a strict protocol incorporating a full clinical, sonographical and biochemical evaluation allow the avoidance of laparoscopy in most cases, and can optimize success rates of MTX and expectant management.