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Utility of a routine ultrasound for detection of ectopic pregnancies among women requesting abortion: a retrospective review.
Duncan, Clara I; Reynolds-Wright, John J; Cameron, Sharon T.
  • Duncan CI; The Medical School, University of Edinburgh, Edinburgh, UK.
  • Reynolds-Wright JJ; Queen's Medical Research Institute, MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK.
  • Cameron ST; NHS Lothian, Chalmers Centre, Edinburgh, UK.
BMJ Sex Reprod Health ; 48(1): 22-27, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1736080
ABSTRACT

INTRODUCTION:

Routine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. However, ultrasound adds complexity to care and results may be inconclusive, delaying abortion. We sought to determine the rate of ectopic pregnancy and the utility of routine ultrasound in its detection, in a community abortion service.

METHODS:

Retrospective case record review of women requesting abortion over a 5-year period (2015-2019) with an outcome of ectopic pregnancy or pregnancy of unknown location (PUL) at a service (Edinburgh, UK) conducting routine ultrasound on all women. Records were searched for symptoms at presentation, development of symptoms during clinical care, significant risk factors and routine ultrasound findings.

RESULTS:

Only 29/11 381 women (0.25%, 95% CI 0.18%, 0.33%) had an ectopic pregnancy or PUL (tubal=18, caesarean scar=1, heterotopic=1, PUL=9). Eleven (38%) cases had either symptoms at presentation (n=8) and/or significant risk factors for ectopic pregnancy (n=4). A further 12 women developed symptoms during their clinical care. Of the remaining six, three were PUL treated with methotrexate and three were ectopic (salpingectomy=2, methotrexate=1). In three cases, the baseline ultrasound indicated a probable early intrauterine pregnancy.

CONCLUSIONS:

Ectopic pregnancies are uncommon among women presenting for abortion. The value of routine ultrasound in excluding ectopic pregnancy in symptom-free women without significant risk factors is questionable as it may aid detection of some cases but may provide false reassurance that a pregnancy is intrauterine.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pregnancy, Ectopic / Abortion, Spontaneous / Abortion, Induced Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Pregnancy Language: English Journal: BMJ Sex Reprod Health Year: 2022 Document Type: Article Affiliation country: Bmjsrh-2020-200888

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pregnancy, Ectopic / Abortion, Spontaneous / Abortion, Induced Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Pregnancy Language: English Journal: BMJ Sex Reprod Health Year: 2022 Document Type: Article Affiliation country: Bmjsrh-2020-200888