Semin Reprod Med 2007; 25(2): 085-091
DOI: 10.1055/s-2007-970047
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Ultrasound Diagnosis of Ectopic Pregnancy

George S. Condous1
  • 1Associate Professor in Gynecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Clinical School, University of Sydney, Nepean Hospital, Sydney, Australia
Further Information

Publication History

Publication Date:
22 March 2007 (online)


The diagnosis of tubal ectopic pregnancy should be based upon the positive visualization of an adnexal mass using transvaginal ultrasound rather than the absence of an intrauterine gestational sac. Ultrasound diagnosis earlier in the natural history of the condition has meant that more conservative treatment options can be considered and implemented in clinically stable women. Although laparoscopy traditionally is accepted as the gold standard in the diagnosis of tubal ectopic pregnancy, there is substantial evidence that transvaginal ultrasound is the diagnostic tool of choice in modern practice. In expert hands, this single noninvasive and reproducible diagnostic test correlates well with the presence of ectopic pregnancy at the time of surgery. This article discusses the use of ultrasound as a single stand-alone test in the diagnosis of tubal ectopic pregnancy.


  • 1 Stovall T G, Ling F W. Single dose methotrexate: an expanded clinical trial.  Am J Obstet Gynecol. 1993;  168 1759-1765
  • 2 Hajenius P J, Engelsbel S, Mol B W et al.. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy.  Lancet. 1997;  350 774-779
  • 3 Fernandez H, Yves Vincent S C, Pauthier S, Audibert F, Frydman R. Randomized trial of conservative laparoscopic treatment and methotrexate administration in ectopic pregnancy and subsequent fertility.  Hum Reprod. 1998;  13 3239-3243
  • 4 Ylostalo P, Cacciatore B, Sjoberg J, Kaariainen M, Tenhunen A, Stenman U H. Expectant management of ectopic pregnancy.  Obstet Gynecol. 1992;  80 345-348
  • 5 Korhonen J, Stenman U H, Ylostalo P. Serum human chorionic gonadotropin dynamics during spontaneous resolution of ectopic pregnancy.  Fertil Steril. 1994;  61 632-636
  • 6 Elson J, Tailor A, Banerjee S, Salim R, Hillaby K, Jurkovic D. Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis.  Ultrasound Obstet Gynecol. 2004;  23 552-556
  • 7 Ankum W M, Van der Veen F, Hamerlynck J V, Lammes F B. Transvaginal sonography and human chorionic gonadotrophin measurements in suspected ectopic pregnancy: a detailed analysis of a diagnostic approach.  Hum Reprod. 1993;  8 1307-1311
  • 8 Cacciatore B, Stenman U H, Ylostalo P. Diagnosis of ectopic pregnancy by vaginal ultrasonography in combination with a discriminatory serum hCG level of 1000 IU/L (IRP).  Br J Obstet Gynaecol. 1990;  97 904-908
  • 9 Condous G, Okaro E, Khalid A et al.. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery.  Hum Reprod. 2005;  20 1404-1409
  • 10 Atri M, Valenti D A, Bret P M, Gillett P. Effect of transvaginal sonography on the use of invasive procedures for evaluating patients with a clinical diagnosis of ectopic pregnancy.  J Clin Ultrasound. 2003;  31 1-8
  • 11 Ankum W M, Van der Veen F, Hamerlynck J V, Lammes F B. Laparoscopy: a dispensable tool in the diagnosis of ectopic pregnancy?.  Hum Reprod. 1993;  8 1301-1306
  • 12 Dutta R L, Economides D L. Patient acceptance of transvaginal sonography in the early pregnancy unit setting.  Ultrasound Obstet Gynecol. 2003;  22 503-507
  • 13 Shalev E, Yarom I, Bustan M, Weiner E, Ben-Shlomo I. Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases.  Fertil Steril. 1998;  69 62-65
  • 14 Brown D L, Doubilet P M. Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics.  J Ultrasound Med. 1994;  13 259-266
  • 15 Walters M D, Eddy C, Pauerstein C J. The contralateral corpus luteum and tubal pregnancy.  Obstet Gynecol. 1987;  70 823-826
  • 16 Jurkovic D, Bourne T H, Jauniaux E, Campbell S, Collins W P. Transvaginal color Doppler study of blood flow in ectopic pregnancies.  Fertil Steril. 1992;  57 68-73
  • 17 DiMarchi J M, Kosasa T S, Hale R W. What is the significance of the human chorionic gonadotropin value in ectopic pregnancy?.  Obstet Gynecol. 1989;  74 851-855
  • 18 Saxon D, Falcone T, Mascha E J, Marino T, Yao M, Tulandi T. A study of ruptured tubal ectopic pregnancy.  Obstet Gynecol. 1997;  90 46-49
  • 19 Condous G, Okaro E, Bourne T. The conservative management of early pregnancy complications: a review of the literature.  Ultrasound Obstet Gynecol. 2003;  22 420-430
  • 20 Condous G. The management of early pregnancy complications.  Best Pract Res Clin Obstet Gynaecol. 2004;  18 37-57
  • 21 Condous G, Okaro E, Khalid A et al.. The use of a new logistic regression model for predicting the outcome of pregnancies of unknown location.  Hum Reprod. 2004;  19 1900-1910
  • 22 Condous G, Okaro E, Khalid A et al.. A prospective evaluation of a single-visit strategy to manage pregnancies of unknown location.  Hum Reprod. 2005;  20 1398-1403
  • 23 Condous G, Okaro E, Bourne T. Pregnancies of unknown location: diagnosis dilemmas and their management.  Curr Opin Obstet Gynecol. 2005;  17 568-573
  • 24 Condous G, Kirk E, Van Calster B, Van Huffel S, Timmerman D, Bourne T. Failing pregnancies of unknown location: a prospective evaluation of the human chorionic gonadotrophin ratio.  Br J Obstet Gynaecol. 2006;  113 521-527
  • 25 Condous G, Jurkovic D, Timmerman D, Goldstein S, Valentin L, Bourne T. Pregnancies of unknown location: consensus statement.  Ultrasound Obstet Gynecol. 2006;  28 121-122

George S CondousM.B.B.S. 

Early Pregnancy and Advanced Endosurgery Unit, Nepean Clinical School, University of Sydney

Nepean Hospital, Sydney, Australia