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Ultraschall Med 2023; 44(01): e47-e61
DOI: 10.1055/a-1487-5030
Original Article

The Predictive Value of Decisive and Soft Ultrasound Criteria for Ectopic Pregnancy Identification in 321 Preoperative Cases

Prädiktiver Wert der definierenden und weichen Ultraschallkriterien in der Diagnostik von 321 ektopen Schwangerschaften
Janna Pape 
1   Department of Gynecology, University Hospital Zürich, Switzerland
,
Anahita Bajka
2   Department of Obstetrics, University Hospital Zürich, Switzerland
,
Deivis Strutas
3   Department of Gynecology, Hospital Lachen, Switzerland
,
Tilo Burkhardt 
2   Department of Obstetrics, University Hospital Zürich, Switzerland
,
Patrick Imesch
1   Department of Gynecology, University Hospital Zürich, Switzerland
,
Daniel Fink
1   Department of Gynecology, University Hospital Zürich, Switzerland
,
Eleftherios Pierre Samartzis
1   Department of Gynecology, University Hospital Zürich, Switzerland
,
Michael Bajka
1   Department of Gynecology, University Hospital Zürich, Switzerland
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Abstract

Purpose To define the predictive value of morphological types (MTs) and further criteria in diagnosing ectopic pregnancy (ECP) by transvaginal sonography (TVS) prior to operative confirmation and treatment.

Materials and Methods Retrospective cohort analysis of 321 consecutive patients with suspected ECP who were advised to undergo operation.

Results ECP was investigated by TVS in all 321 patients. Application of the five selected MTs (blob sign, bagel sign, yolk sac, embryo, heart action) resulted in 85 % of cases receiving a conclusive diagnosis and 12 % receiving a presumed ECP diagnosis. 3 % remained nondiagnostic due to large or multiple ovarian cysts, large myoma, extended hemoperitoneum, or severe pain. ECP diagnosis was confirmed intraoperatively in 97 % of cases and was otherwise (3 %) immediately followed by curettage (CUR). The assessment of free fluid by TVS was achieved in most cases and correlated significantly with free blood. In the majority of cases, free blood was not bound to transmural ECP rupture. Histology confirmed the ECP diagnosis directly or by exclusion in 99 % of cases. Three cases of tubal ECP were diagnosed by TVS but not confirmed by LSC (1 %) and, finally, histology from CUR proved miscarriage (false-positive rate 1 %).

Conclusion We confirm the high accuracy of TVS diagnosis of ECP relying on five clearly different MTs, independent of its location. The blob and bagel sign emerged as important types (75 % of all ECPs). Histology from CUR was needed when ECP could not be visualized in LSC. Assessment of free fluid was essential and accurate in predicting free blood.

Zusammenfassung

Ziel Bestimmung des prädiktiven Werts von morphologischen Typen (MT) sowie weiterer Kriterien bei der Diagnose ektoper Schwangerschaften (ECP) mittels transvaginaler Sonografie (TVS) vor operativer Bestätigung und Therapie.

Material und Methode Retrospektive Kohortenanalyse von 321 Patientinnen mit Verdacht auf ECP, bei denen die operative Therapie empfohlen wurde.

Ergebnisse ECP wurde mittels TVS bei 321 Patientinnen untersucht. Die Anwendung der 5 ausgewählten MT (Blob, Bagel, Dottersack, Embryo, Herzaktion) führte bei 85 % zu einer schlüssigen und bei 12 % zu einer vermuteten ECP-Diagnose, 3 % der ECP konnten aufgrund von Eierstockzysten, Myomen, ausgedehntem Hämoperitoneum oder starken Schmerzen nicht diagnostiziert werden. Die sonografische Diagnose einer ECP wurde bei 97 % der Fälle intraoperativ bestätigt; bei fehlender Darstellbarkeit (3 %) erfolgte im Anschluss eine Kürettage. Freie Flüssigkeit wurde mittels TVS korrekt beurteilt und korrelierte signifikant mit freiem Blut intraoperativ, wobei dies mehrheitlich nicht an eine ECP-Ruptur gebunden war. Die Histologie bestätigte die ECP-Diagnose direkt oder indirekt in 99 % der Fälle. Drei tubare ECP wurden mittels TVS diagnostiziert, jedoch intraoperativ nicht bestätigt (falsch positive Rate: 1 %).

Schlussfolgerungen Wir bestätigen den hohen prädiktiven Wert der sonografischen ECP-Diagnostik anhand der 5 unterschiedlichen MT, unabhängig von ihrer Lokalisation. Blob und Bagel erwiesen sich dabei als wichtige Typen (75 % aller ECP). Die Histologie der Kürettage war erforderlich, sofern die ECP intraoperativ nicht gefunden wurde. Die sonografische Beurteilung der freien Flüssigkeit ist für die Vorhersage von freiem Blut wesentlich.

Key words

transvaginal sonography - blob sign - bagel sign - laparoscopy - ectopic pregnancy


Publication History

Received: 28 October 2020

Accepted: 09 April 2021

Article published online:
06 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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