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Cesarean scar ectopic pregnancy is one of the rarest of all ectopic pregnancy increase in number of cesarean section leads to increase in number of cesarean scar ectopic pregnancy. Early diagnosis and prompt management help in reducing mortality and morbidity occuring due to scar ectopic pregnancy. We are reporting a rare case of cesarean scar ectopic pregnancy G5P3L3D1 with period of gestation 7 weeks 3 days with previous all 4 deliveries by cesarean section. Cesarean scar ectopic pregnancy are life threatening as they pose a great risk of maternal hemorrhage as the patient vital are the stable patient managed medically with injection Methotrexate
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Objectives:To assess the feasibility of diagnos?c hysteroscopy in the diagnosis of abnormal structure and pathological lesions in the uterine cavi?es of women presen?ng abnormal bleeding of the uterus. Methods: This is a Prospec?ve Cross-sec?onal study conducted in the Department of Gynaecology at Prathima Ins?tute Of Medical Sciences, Karimnagar: one hundred women presen?ng with Abnormal Uterine Bleeding, over a period of one year from December 2020 to November 2021, were subjected to the procedure. Results: The results of our study show that hysteroscopy has high accuracy for detec?ng the pathology in women with abnormal uterine bleeding, especially in benign lesions such as endometrial polyp and submucosal fibroid and it can be used as the first line diagnos?c method for these abnormali?es. Conclusion:Hysteroscopy provides a more accurate diagnosis than dilata?on and cure?age or ultrasonography alone to diagnose pathology in women with abnormal bleeding of the uterus. It is very sensi?ve for diagnosing intracavitary lesions like submucous myoma and endometrial polyp
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Background: Postmenopausal bleeding (PMB)accounts for 5% of gynecology visit. All with unexpected uterine bleeding should be evaluated for endometrial carcinoma since this potentially lethal disease is the cause of bleeding in approximately 10 percent patients (range 1 to 25 percent, depending upon risk factors). The aim of the study was to evaluate endometrial causes of postmenopausal bleeding (PMB) with it's correlation with endometrial thickness (ET)and hysteroscopy findings and endometrial tissue histopathology.Methods: A total 50 consecutive cases of PMB fulfilling the inclusion and exclusion criteria and giving informed consent were selected. Each patient was subjected to transvaginal sonography (TVS) in which uterus, adnexa and endometrial thickness (ET) was assessed. Then hysteroscopy and/or dilation and curettage was scheduled at subsequent visit. Endometrial sample was sent for histopathological examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for ET by TVS and hysteroscopy findings, considering histopathological diagnosis as the gold standard.Results: Most common endometrial cause of PMB was atrophic endometrium (44%). The other causes were endometrial carcinoma (18%), endometrial hyperplasia (18%), endometrial polyp (12%), endometritis (4%), and leiomyoma (4%). The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%.Conclusions: Being relatively cheap, easily accessible, non-invasive, TVS with ET measurement should first line investigation in the evaluation of women with postmenopausal bleeding with suspected endometrial pathology. Although hysteroscopy is more specific and sensitive, in poor resource settings it should be limited to cases with ill-defined endometrial lining, recurrent/ persistent bleeding and cases with endometrial thickness greater than 5 mm irrespective of endometrial echotexture.
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Caesarean scar ectopic involves an abnormal implantation of the embryo within the myometrium of previous caesarean scar. It is a rare and serious entity involving maternal complication like abnormal placentation, hemorrhage or death due to uterine rupture. Authors present a case report of 32 years old female diagnosed as a case of caesarean scar ectopic pregnancy on TVS and MRI and managed conservatively by USG guided D and C.
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Background: The objectives of the study was to establish the role of histopathological diagnosis of uterine endometrial lesions in patients of AUB at perimenopausal age and to correlate the transvaginal sonographic (TVS) finding with histopathological examination.Methods: This prospective observational study was carried out over 1 and 1/2 years in the two apex level teaching hospitals in eastern India. A total of 197 women in the age group of 40-49 years and ≥50 years (up to 55 years) who presented with abnormal uterine bleeding were included in the study. After selecting the patient with eligibility criteria in the OPD, detailed clinical history, systemic and gynecological examinations and investigations were done as per proforma. TVS study of endometrial pattern and thickness was measured followed by dilatation and curettage (D and C) and HPE of the endometrial curetting was done.Results: Menorrhagia (44.67%) was the most common clinical finding. Mean endometrial thickness measured by TVS was 7.04±2.11 mm in proliferative phase and 10.25±1.27 mm in the secretory phase. Proliferative endometrium (37.06%) was the most frequent finding in HPE followed by secretory endometrium (20.3%). Hyperplasia of endometrium was noted in 27 cases (100%) at 12-15 mm of endometrial thickness on TVS whereas endometrial hyperplasia with and without atypia and endometrial carcinoma was noted in 25 cases (92.59%) at the same thickness of 12-15 mm of uterine endometrium on HPE. Endometrial hyperplasia and polyp both had sensitivity of 84.21% and 71.43% respectively on TVS as compared with histopathology.Conclusions: Increased endometrial thickness and echo pattern by TVS correlated well with abnormal endometrial tissue histopathology in perimenopausal women with AUB.
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Background: Abnormal uterine bleeding is the most common complaint in gynaecology and an important source of morbidity. The ideal diagnostic tool to determine the cause for the same continues to be debated. Objective of this study was to compare accuracy of hysteroscopy and transvaginal sonography in diagnosis of endometrial pathology in abnormal uterine bleeding.Methods: A total 100 women attending gynaecological outpatient in hospital attached to J. J. M. Medical College, Davangere with abnormal uterine bleeding fitting into the inclusion criteria during November 2014 to August 2016, were admitted and evaluated with Transvaginal sonography (TVS) and hysteroscopy. Data was collected and analysed.Results: Among 100 patients of AUB in this study, majority of the patients were in perimenopausal age group. Menorrhagia is the most common presentation (45%) followed by postmenopausal bleeding (20%). Anaemia was detected in 79% of patients. Hysteroscopy was taken as gold standard and TVS findings were compared. The sensitivity of TVS in detecting polyps, submucous fibroid were 22.2%, 11% respectively and for the normal variants like proliferative and secretory it was 50% and 79.2% respectively. TVS showed good correlation with hysteroscope findings for normal variants of endometrium, but poor correlation for intracavitary pathologies.Conclusions: Hysteroscopy is a rapid, safe, well tolerated and highly accurate means of diagnosing the cause of abnormal uterine bleeding in perimenopausal age group. Thus, it is advised as a first line investigation in evaluation of AUB.
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Background: Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine because the aetiology is often unknown and there are only few evidence-based diagnostic and treatment strategies. Objective of this study was to compare the role of trans vaginal sonography with hysteroscopy in detection of uterine causes of abortions.Methods: This prospective cohort study was conducted in the department of obstetrics and gynaecology, Kasturba Hospital, Daryaganj, Delhi. The study was conducted from January 2016 to December 2016.Results: On transvaginal sonography majority of women i.e. 39(78%) patients had normal ultra-sonographic findings. 11(22%) showed various abnormal findings. Most commonly diagnosed abnormal finding on TVS was polyp, seen in 5(10%) patients. It was seen as a well-defined, uniformly hyperechoic mass within the endometrial cavity. normal hysteroscopic findings were seen in 27(54%) patients. Rest 23(46%) patients had abnormal uterine factors as diagnosed by hysteroscopy.Synechiae was detected in 9(18%) patients. It was the most common abnormality detected on hysteroscopy. Out of 9 patients who had synechiae, 2 had severe dense adhesions. In 6 patients, the adhesions were mild and flimsy. While minimal adhesions were noted in 1 patient, seen near the cornua.Conclusions: hysteroscopy is still the gold standard for diagnosis and most definitive procedure of choice if any kind of operative intervention is required.
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Background: One of the most important and underappreciated reproductive health problems in developing countries is that of infertility. Objective of this study was to evaluate HSC (hysteroscopy), HSG (hysterosalpingography) and ultrasonography in infertility.Methods: This study was conducted among 100 infertile patients over a period of two years. The patients were questioned for the detailed history including socioeconomic status, medical history and previous history of taking any medications and supplements. The recruited patients had to undergo.Results: Transvaginal sonography and clinical examination were done. Transvaginal sonography detected abnormality in 40% of women. 65 women had normal hysterosalpingography findings whereas the rest 35 women had abnormal hysterosalpingography findings. Thirty nine percent (39%) had normal hysteroscopic findings while sixty one percent (61%) had abnormal findings. The study depicts that hysteroscopy has sensitivity (95%) and negative predictive value NPV (92%) whereas that of TVS is 48.9% and 44.9% respectively. Hysterosalpingography has sensitivity 68.3% and NPV 40.3%. Specificity (100%) and positive predictive value PPV (100%) of all the three modalities are the same.Conclusions: The results of the present study showed that each modality provided useful information but no single modality provided complete information for evaluating infertile women. Thus, a combination of all three modalities- TVS (transvaginal sonography), HSG (hysterosalpingography) and hysteroscopy is necessary to evaluate infertile women.
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Background: Saline infusion sonohysterography (SIS) is a simple, safe, reliable, effective and well-tolerated method without complications that complements transvaginal sonography (TVS) in the pre-operative examination of uterine pathology. SIS has been found to be superior to TVS in most studies that have compared their effectiveness in detecting intracavitary lesions and has also been found to decrease the number of diagnostic hysteroscopies to as much as 50%. Patients in whom no intracavitary abnormality is detected by SIS require no further evaluation and are best treated with medical therapy.Methods: The observational study was conducted in the postgraduate department of gynaecology and obstetrics, Lalla Ded Hospital, Government Medical College Srinagar. All consecutive patients with perimenopausal abnormal uterine bleeding attending gynaecology OPD were enrolled in the study after taking informed written consent.Results: SIS has better accuracy than TVS in diagnosing the cause of AUB in perimenopausal women. TVS had sensitivity, specificity and PLR of 60 and 93.8, 9.8, respectively for fibroids while polyps had 27.3, 98.8 and 17.5, respectively, AUP had 81.8, 79.2, 3.9 respectively. SIS had sensitivity, specificity, PLR and NLR values of 80.0, 96.9, 40.7 and 0.21, respectively for diagnosing fibroids, while 63.6, 98.4, 26 and 0.37 respectively for polyp, and 90.9, 94.3, 16.1 respectively for AUP.Conclusions: Accuracy of SIS as a test for detecting pathology in AUB in perimenopausal patients is moderately good and suitable for developing countries.
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Background: Abnormal uterine bleeding is one of the most frequently encountered conditions in gynaecology practice and forms about 10% of all gynaecological admissions, the main concern in perimenopausal bleeding is that the bleeding could be the only external manifestation of many hidden serious pathologies of uterine-cavity. The objective of this study was to compare the results of transvaginal sonography (TVS) and drug and cosmetic (D and C) with histopathological examination (HPE) report of hysterectomy specimen in perimenopausal women with AUB.Methods: A prospective comparative study where 100 perimenopausal women with AUB were subjected to TVS then D and C and then the results were compared with histopathological report of the hysterectomized specimen.Results: With an endometrial thickness less than or equal to 15 mm the histopathology report is normal endometrium. When the endometrial thickness more than or equal to 15 mm the histopathology report is hyperplasia or carcinoma. Findings of TVS correlated well with histopathological report after hysterectomy. 14 cases of adenomyosis, 16 cases of myomatous polyp, and 6 cases of endometrial polyp missed by dilatation and curettage.Conclusions: TVS is a simple, non-invasive test to indirectly visualize the endometrial cavity and is useful as a first step diagnostic procedure in the evaluation of perimenopausal bleeding. Dilatation and curettage lags in detecting adenomyosis, endometrial and myomatous polyps, When TVS combined with dilatation and curettage, it can supplement the shortcomings of dilatation and curettage.
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Background: Significant number of induced pregnancies land in caesarean delivery. Cervical assessment is integral to successful outcome of induction of labour. Objective of this study was to study preinduction transvaginal ultrasonographic cervical length and to compare it with Bishop Score in predicting successful labour.Methods: This prospective study was conducted at the department of obstetrics and gynaecology, MMIMSR, Mullana, Ambala on 150 patients. A total of 150 women were studied from January 2015 to June 2016 after taking an informed consent. The sociodemographic particulars were recorded, detailed history was taken and examination performed. Transvaginal ultrasound was done to assess cervical length after evacuation of bladder. Bishop score was then determined by separate observer. The occurrence of vaginal delivery was considered as primary outcome. All statistics collected were entered in statistical software SPSS-15. ROC curves were constructed for both Bishop Score and TVS.Results: The mean gestational age was 38 week 6 days, majority 134 (89.3%) being less than 40 weeks of gestation. The ROC curve for Bishop Score demonstrated better predictability compared to cervical length by TVS. Optimized cut off for Bishop score in addition to TVS was determined by ROC curve to predict successful vaginal delivery, it was ≥ 6 for Bishop score (sensitivity 90.7%, specificity 68.6%, positive predictive value 91.5% and negative predictive value 66.7%) and ≤ 3.0 cm for cervical length on TVS (sensitivity 74.6%, specificity 51.6%, positive predictive value 74.5% and negative predictive value 51.6%). The relation of both cervical length and Bishop score with successful vaginal delivery was found to be statistically significant with p value of 0.0001.Conclusions: The present study indicates that Bishop Score is a better predictor for successful vaginal delivery as compared to cervical length by transvaginal ultrasonography.
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Background: Induction of labor is the most common intervention in modern obstetrics. The pre-induction ‘favourability’ of the cervix as assessed by the bishop score is very subjective. Transvaginal sonography appears to be a feasible alternative to the traditional bishop’s score. Aim of this study, was to compare cervical assessment by transvaginal sonography and digital examination in prediction of outcome of labor induction.Methods: Three hundred women at term with maternal and foetal indications for labor induction were included in the study. Modified Bishop score was assessed by digital examination and the cervical length was measured by Transvaginal sonography (TVS). Successful labor induction was taken as a vaginal delivery within 24 hours from the start of induction. Data were analyzed using SPSS for Windows 15.0.Results: Labour induction was successful in 81.33% of patients. Mean cervical length by digital examination was 2.6 cm, whereas the mean sonographic cervical length was 3.4cm. There was a significant difference of 0.8cm in mean cervical length measured by two methods (P=0.01). The best cut off point for predicting successful induction of labor was ≤3.4cm for sonographic cervical length (sensitivity 0.82, specificity 0.87, positive predictive value 0.77 and negative predictive value 0.25). The best cut off point for Modified Bishop score was 2 (sensitivity 0.95, specificity 0.93). The ROC curve showed that compared to TVS cervical length, Modified Bishop score was the best parameter for predicting successful induction of labor.Conclusions: Transvaginal sonographic cervical length measurement can be used as an adjunct tool to the traditional Bishop score for predicting successful labor induction in high risk pregnancies.
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The pregnancy is one of the most fascinating experiences which a woman undergoes in her life and of the whole, the first trimester is a vital time as the pregnancy gets established. The last menstrual period (LMP) is generally used as a landmark for pregnancy dating, and the first trimester of pregnancy is defined as 12 weeks after the LMP. The first recognizable structure inside the gestational sac is the yolk sac, which should be detectable as a regularly rounded extra-amniotic structure when the gestational sac reaches dimensions of 8 to 10 mm. In a normal pregnancy it should be possible to observe the yolk sac between 6-12 weeks of pregnancy or when it reaches 10 mm in size. Ultrasonography shows the yolk sac as a round structure that is made up of an anechoic center bordered by a regular well-defined echogenic rim. The normal shape of yolk sac is circular. The yolk sac appears at 6 weeks, thereafter increases in size, attains its maximum diameter at 10 weeks and then it starts decreasing in size. It disappears at 12 weeks. Aim and Objectives of the present study is to study the shape of yolk sac in pregnant females, in the first trimester of pregnancy and to find it's correlation with spontaneous abortion. We studied 72 pregnant females, who were in their first trimester of pregnancy, referred by Department of Obstetrics and Gynaecology. The shape of yolk sac was observed by transvaginal sonography and its correlation with spontaneous abortion was studied. Yolk sac was present in 70 cases (97.22%) and in two cases (2.78%), it was absent. In 68 (97.14%) cases the shape of yolk sack was circular. It was irregular (1.4%) and oblong (1.4%) in one case each.
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Objective To investigate age-related changes in serum tumor markers carbohydrate antigen 125 (CA125),CA153 and CA199,and the clinical significance of separate and combined detection of these markers for screening endometrial carcinoma(EC) in elderly women with intrauterine abnormalities on transvaginal ultrasound (TVS).Methods Cross-sectional data of 420 elderly women suspected of having an intrauterine abnormality by TVS and undergone hysteroscopy with dilation and curettage from January 2010 to December 2017 were retrospectively analyzed.Patients were divided into a 60-64 years-old group and a 65-83 years-old group.Aging-related changes in positive rates of CA125,CA153 and CA199 were compared between the two groups.Differences in positive rates of tumor markers were compared between different pathological types.Using postoperative pathological diagnosis as the gold standard for EC,the diagnostic sensitivity,specificity and accuracy of serum CA125,CA153 and CA199 alone or in combination for EC were calculated.Results The positive rates of CA125,CA153 and CA199 were 3.9％(16/412),0％(0/172)and 5.0％ (20/404),respectively.The positive rate of CA125 was higher in the 65-83 years-old group(6.5％,16/246)than in the 60-64 years-old group(0.0％,0/166) (P =0.001).The positive rates of CA125 and CA199 in patients with EC were 14.3％ (4/28)and 42.9％ (12/28),which were higher than those in patients with other pathological types.However,the sensitivity of single and combined detection of CA125 and CA199 was too low for the diagnosis of EC(14％、43％).Conclusions The single and combined detection of CA125,CA153 and CA199 for screening EC is of limited value in elderly women.New tumor markers need to be identified and used in combination with TVS for screening EC in elderly women.
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Background: Tamoxifen is given in women with breast cancer who underwent surgery and is receptor positive. As Tamoxifen increases the risk of endometrial carcinoma to 2% a screening technique such as transvaginal sonography is essential to identify women at risk of endometrial cancer. Aim: To identify endometrial pathology in women using tamoxifen after surgery for breast cancer Material and methods: Fifty women on tamoxifen for breast cancer attending the department of radiotherapy were screened once in six months by history taking, clinical examination and measuring endometrial thickness with TVS. Endometrial biopsy for histology was performed in women with endometrial thickness more than 11 mm Observation: Endometrial biopsy was performed in ten women who were found to have endometrial thickness > 11 mm. Out of ten, four had normal endometrium, three had simple hyperplasia one was found to have complex endometrial hyperplasia without atypia and two were reported to have inadequate endometrium. Conclusion: Routine screening with TVS is not a cost effective measure as tamoxifen induces subepithelial stromal hypertrophy resulting in minimal tissue yield on endometrial biopsy. Therefore bleeding should remain the primary trigger for investigation of women on tamoxifen.
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Background: Abnormal uterine bleeding (AUB) is the most common reason for gynecological visits for perimenopausal bleeding and may account for more than 25% of all hysterectomies. Objective: This study was aimed to review the causes of abnormal uterine bleeding in perimenopausal women establishing the correlation with ultrasonographic and histopathological examinations. Study Method: This descriptive study was conducted in the department of gynecology and obstetrics, Ibn Sina Medical College, Dhaka during January to December 2012. Two hundred and eleven women were selected for this study, who admitted into the hospital with abnormal uterine bleeding in perimenopausal age. The clinical, ultrasonographic and histopathological findings of these women were evaluated in this study. Results: Menorrhagia was the major symptom (52.6%) irrespective of age and parity. All these women underwent D&C followed by either medical management or hysterectomy depending upon the diagnosis. The histopathological findings of endometrium were analyzed and confirmed as fibroid uterus (58.28%) and DUB (17.58%) correlated well with transvaginal sonography (TVS) and histopathological examination. Hysterectomy conferred other uterine lesions as adenomyosis (18.71%), endometrial polyp (4.81%) and malignancy (1.06%). Conclusion: Abnormal uterine bleeding in perimenopausal age group is a common but ill-defined entity which needs proper evaluation. Accurate diagnosis of the causative factors of AUB in this age group is of utmost importance so that appropriate management can be established early that leads the minimization of the patients’ sufferings.
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We compared Transvaginal Sonography (TVS) with histopathological results of the dilatation and curettage biopsies in 50 women with postmenopausal bleeding attending Gynaecology out-patient department of SMGS hospital, Jammu. These women underwent TVS followed by histopathological examination of endometrium. Endometrial lesions detected by histopathology in these women were: hormonal effects (proliferative and secretary endometrium) in 5 (10%), endometrial polyps in 4 (8%), endometritis in 2 (4%), endometrial hyperplasia in 9 (18%) and endometrial carcinoma in 5 (10%). A total of 21 (42%) showed atrophic endometrium and in 4 (8%) women, sample was insufficient. On TVS, 24 (48%) women had endometrial thickness (ET) < 5 mm and 26 (52%) women had ET > 5 mm. At a cut-off limit of > 5 mm for endometrial thickness indicating pathologic endometrium, the sensitivity and specificity of TVS was 100% and 80% respectively and a predictive value as a positive test, as a negative test and accuracy was 76.9%, 100% and 89% respectively. This study shows that TVS allows detection of endometrial pathology in vast majority of women and it is relatively easy, cheap, non-invasive and does not require anesthesia. It can be used as the first diagnostic step in the investigations of women with postmenopausal bleeding.
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Background & objectives The length of cervix predicts the risk of preterm delivery. The objective of this study was to assess cervical length in pregnancy by transvaginal ultrasonography for generating normative data for nulliparous women at no special risk of preterm labour. Methods An observational study was carried out in a tertiary care teaching hospital in eastern India in nulliparous women who delivered at term. A single sonologist assessed 224 women (once per subject) between 20 and 34 wk of gestation. Nulliparous women carrying a single foetus of confirmed gestational age were included; 216 subjects were finally considered for generation of normative data, excluding those delivering earlier than 37 or later than 42 wk. Other exclusion criteria were history of cerclage, any previous cervical surgery, smoking, or any medical disorder complicating pregnancy. Results Cervix length at each week of gestation gradually decreased over the study period. Length at 20 and 34 wk was 40.5 ± 1.14 mm (mean ± SD) and 34.8 ± 1.34 mm respectively. The overall shortening over this 14 wk period was 5.7 mm, with 0.58 mm per week median rate of shortening. Pearson's correlation coefficient was - 0.69 (95% CI - 0.75 to - 0.60; P< 0.001) for cervical length vis-à-vis gestational age. Interpretation & conclusions The serial normative data generated in our setting can be used to decide cut-off points for predicting risk of preterm labour in future studies. Validity of such prediction needs to be tested in larger cohorts of women assessed at specific gestational ages.
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Adolescent , Adult , Data Collection , Female , Gestational Age , Humans , India , Organ Size , Pregnancy , Premature Birth/diagnosis , Regression Analysis , Risk Assessment , Ultrasonography, Prenatal/methodsABSTRACT
A case of twin tubal pregnancy was reported. The patient presented with lower abdominal pain with some vaginal bleeding and was diagnosed with transvaginal sonography at approximately eight weeks of gestation. An uneventful salpingectomy was subsequently performed.
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Objectives To study ho to make an accurate diagnosis of ectopic pregnancy in the early stage through different ultrasonic checking ways, so as to decrease the misdiagnosis and missed diagnosis rates. Methods 195 cases of ectopic pregnancy patients, which were diagnosed by abdominal ultra-sound (TAS) or by vagina ultra-sound (TVS), were collected, then compared with the operational pathological results and anzlyzed the reasons of the misdiagnosis and missed diagnosis, so as to find out the best ultrasonic way. Results 195 cases of ectopic pregnancy patients were diagnosed by ultrasound, the positive coincidence rate was 95.4% (186/195), misdiagnosis rate was 4.1% (8/195) and missed diagnosis rate was 0.5% (only 1 case). Among 186 cases of ectopic pregnancy, which totally conformed to the operational pathological results, 82 cases were pelvic adhesion, 51 cases (62.2%) were diagnosed ectopic pregnancy by TAS. 104 cases were not pelvic adhesion, in which 48(46.2%) cases were diagnosed ectopic pregnancy by TAS, then the significant differences were being shown. Conclusions When in pelvic adhesion, the ultrasonic checking way is mutually related to the positions of the oviduct and ovary in the pelvic cavity. When the oviduct and ovary are pressed close to the anterior abdominal wall, TAS is the best way while they are pressed close to posterior pelvic wall, TVS is the best way. The ultrasonic checking way for ectopic pregnancy is varied upon different patients.It is the main reason of misdiagnosis and missed diagnosis, that the clinical material and dynamic observation were not taken into consideration