Analysis of sonographic findings in patients with suspected ectopic pregnancy

ABSTRACT

To investigate the diagnostic value of various sonographic findings in patients with suspected ectopic pregnancy. Prospective analytic study conducted over 5 years period from January 1990 through December 1994. Setting: Lady Willingdon Hospital, Lahore. 280 consecutive and haemodynamically stable women with suspected diagnosis of ectopic pregnancy. Transabdominal ultrasonography. Comparison of various sonographic findings in patients with and without ectopic pregnancy. Diagnostic indices for various sonographic findings were calculated. 56 patients were finally diagnosed to have ectopic pregnancy. The sensitivity, specificity, positive predictive value and negative predictive value of ultrasonic diagnosis were 83.9%, 87.9%, 63.5%and 95.6% respectively. Ultrasonic findings in ectopic pregnancy included an intact ectopic gestational sac in 2 [3.6%] cases, adnexal mass in 34 [60.7%] cases, free fluid in the cul-de-sac in 32 [57.1%] cases, and no abnormality In 10 [17.8%] cases. An intact ectopic ring had the best predictive value [100%] followed by combination of a complex adnexal mass and fluid in cul-de-sac [76.5%] but the sensitivity of these signs was only 3.6% and 23.2% respectively. Prospective use of real-time transabdominal ultrasonography gives an accurate diagnosis of an ectopic pregnancy in 84% affected cases. The most reliable feature is the presence of a living adnexal embryo. A strong presumptive evidence for an ectopic pregnancy is provided by the sonographic evidence of adnexal masses and/or fluid in the cul-de-sac