Advertisement

Transvaginal sonographic findings of chronic ectopic pregnancy

  • Cem Turan
    Correspondence
    Corresponding author, Yildiz Bloklari A-3 No. 34, 06170 Yenimahalle, Ankara, Turkey.
    Affiliations
    Department of Obstetrics, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Gynecology, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Ultrasonography, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey
    Search for articles by this author
  • Mustafa Ugur
    Affiliations
    Department of Obstetrics, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Gynecology, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Ultrasonography, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey
    Search for articles by this author
  • Muammer Dogan
    Affiliations
    Department of Obstetrics, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Gynecology, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Ultrasonography, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey
    Search for articles by this author
  • Eyüp Ekici
    Affiliations
    Department of Obstetrics, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Gynecology, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Ultrasonography, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey
    Search for articles by this author
  • Kubilay Vicdan
    Affiliations
    Department of Obstetrics, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Gynecology, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Ultrasonography, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey
    Search for articles by this author
  • Oya Gökmen
    Affiliations
    Department of Obstetrics, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Gynecology, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey

    Department of Ultrasonography, Dr. Zekai Tahir Burak Women's Hospital, Ankara, Turkey
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Chronic ectopic pregnancy is not precisely defined in gynecologic and sonographic texts. The diagnosis of this enigmatic clinical condition is frequently not made until laparotomy. In the present retrospective study, we evaluated the transvaginal sonographic findings of cases who were diagnosed as chronic ectopic pregnancy intraoperatively and/or postoperatively. The incidence of chronic ectopic pregnancy was found to be 20.3% (Math Eq) of all ectopic pregnancies. Of these 62 cases, 55 had transvaginal sonographic examination. On transvaginal sonographic examination, all 55 cases of chronic ectopic pregnancy had a complex adnexal mass with an empty uterus and only 18 (32.7%) had simple fluid in the pelvis/cul-de-sac. In the majority of cases (82.7%, n = 48), there was a non-homogenous echo pattern within the adnexal mass. Of 55 cases, 30 had color Doppler flow examination, of whom none had color Doppler flow imaging on the wall of the mass or within the mass. There was a negative quantitative β human chorionic gonadotropin (β-hCG) assay (i.e. 0 mIU/ml) in only 4 cases. Based on this study, we concluded that chronic ectopic pregnancy is not a rare clinical entity and should be considered in differential diagnosis among patients presenting with an adnexal mass and an overt clinical picture. Transvaginal sonography is sensitive in diagnosing chronic ectopic pregnancy, but not specific. The combined use of transvaginal ultrasonography and β-hCG assay increases diagnostic accuracy. However, it should be kept in mind that a negative β-hCG value does not rule out chronic ectopic pregnancy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      References

        • Rock JA
        Ectopic pregnancy.
        in: Thompson JD Rock JA Te Linde's Operative Gynecology. seventh edition. J.B. Lippincott Company, Philadelphia1994: 411-435
        • Clark JEJ
        • Bryant W
        Chronic ectopic pregnancy.
        J Natl Med Assoc. 1975; 67: 118-122
        • Bedi DG
        • Moeller CJ
        • Fagan CJ
        Chronic ectopic pregnancy: a comparison with acute ectopic pregnancy.
        Eur J Radiol. 1987; 7: 46-48
        • Henderson DN
        • Bean JLM
        Early extrauterine pregnancy.
        Am J Obstet Gynecol. 1950; 59: 1225-1229
        • Riva HL
        • Kammeraad LA
        • Anderson PS
        Ectopic pregnancy — report of 132 cases and comments on the role of culdoscope in diagnosis.
        Obstet Gynecol. 1962; 20: 189-193
        • Levy NB
        • Goldberger SB
        • Batchelder CS
        Chronic ectopic pregnancy: a survey of 54 cases.
        S Afr Med J. 1984; 65: 727-729
        • Bedi DG
        • Fagan CJ
        • Nocera RM
        Chronic ectopic pregnancy.
        J Ultrasound Med. 1984; 3: 347-352
        • Cole T
        • Corlett RC
        Chronic ectopic pregnancy.
        Obstet Gynecol. 1982; 59: 63-68
        • Parker SL
        • Parker RT
        Chronic ectopic tubal pregnancy.
        Am J Obstet Gynecol. 1957; 74: 1165-1180
        • Rogers WF
        • Shaub M
        • Wilson R
        Chronic ectopic pregnancy: ultrasonic diagnosis.
        J Clin Ultrasound. 1977; 5: 257-259
        • Ekici E
        • Yapar EG
        • Gökmen O
        • Danisman N
        • Özmen S
        Ectopic pregnancy: transvaginal sonographic findings of 152 cases.
        Ultrasound Obstet Gynecol. 1993; 3: 271-275
        • Ankum WM
        • Van der Veen F
        • Hamerlynck JVThH
        • Lammes FB
        Transvaginal sonography and human chorionic gonadotropin measurements in suspected pregnancy: a detailed analysis of a diagnostic approach.
        Hum Reprod. 1993; 8: 1307-1311
        • Cacciatore B
        • Ylöstalo P
        • Stenman UH
        • Wildholm O
        Suspected ectopic pregnancy: ultrasound findings and hCG levels assessed by an immunofluorometric assay.
        Br J Obstet Gynaecol. 1988; 95: 497-502
        • De Crespingy LC
        Demonstration of ectopic pregnancy by transvaginal ultrasound.
        Br J Obstet Gynaecol. 1988; 95: 1253-1256
        • Nyberg DA
        • Mack LA
        • Laing FC
        • Brooke JR
        Early pregnancy complications: endovaginal sonographic findings correlated with human chorionic gonadotropin levels.
        Radiology. 1988; 158: 619-624
        • Shapiro BS
        • Cullen M
        • Taylor KJW
        • DeCherney AH
        Transvaginal ultrasonography for the diagnosis of ectopic pregnancy.
        Fertil Steril. 1988; 50: 425-429
        • Stiller RJ
        • Haynes de Reght R
        • Blair E
        Transvaginal ultrasonography in patients at risk for ectopic pregnancy.
        Am J Obstet Gynecol. 1989; 161: 930-933
        • Timor-Tritsch IE
        • Yeh MN
        • Peisner DB
        • Lesser KB
        • Slavik DA
        The use transvaginal ultrasonography in the diagnosis of ectopic pregnancy.
        Obstet Gynecol. 1989; 161: 157-161
        • Aleem FA
        • DeFazio M
        • Gintautas J
        Endovaginal sonography for the early diagnosis of intrauterine and ectopic pregnancies.
        Hum Reprod. 1990; 5: 755-758
        • Nyberg DA
        • Hughes MP
        • Mack LA
        • Wong KY
        Extrauterine findings of ectopic pregnancy at transvaginal US: importance of echogenic fluid.
        Radiology. 1991; 178: 823-826
        • Maklad NF
        • Wright CH
        Grey scale ulrasonography in the diagnosis of ectopic pregnancy.
        Radiology. 1978; 126: 221-225
        • Brown TW
        • Filly RA
        • Laing FC
        Analysis of ultrasonographic criteria in the evaluation for ectopic pregnancy.
        Am J Roentgenol. 1978; 131: 967-969