Value of Transvaginal Sonography in Antenatal Management of Ectopic Pregnancy

Abstract

Introduction: Ectopic pregnancy is a high-risk condition which can lead to mortality and morbidity if not diagnosed and managed promptly. Transvaginal Sonography (TVS) has a major role in diagnosing ectopic pregnancy. Certain signs if identified accurately on TVS examination can help predict or exclude ectopic pregnancy precisely.

Aims & Objectives: To determine the diagnostic accuracy of TVS examination in detecting ectopic pregnancy. It also aims to highlight the need of TVS examination in routine antenatal care during early pregnancy.

Place and duration of study: The study was carried out at Shaikh Zayed Hospital, Lahore with the collaborated effort of Radiology Department and Department of Gynae & Obs. It was conducted over the period of three years from 1-1- 2017 to 31-12-2019.

Material & Methods: In this observational study 160 women with suspected ectopic pregnancy were evaluated with ? - HCG levels and TVS examinations. Per-operative findings were taken as the gold standard for patients who underwent laparoscopy/laparotomy, and a trend of ?-HCG for patients with expectant/medical managements per RCOG guidelines. Statistical analyses were applied to find out diagnostic accuracy of TVS findings. The prospective study pattern with close follow-ups and a managing protocol according to the guidelines were required to reinforce the results.

Results: The sensitivity of TVS in diagnosing Ectopic Pregnancies (EPs) in clinically suspected patients were found to be 92.5%, specificity 84.62%, positive predictive value 94.91%, negative predictive value 78.57% and accuracy rate was calculated as 90.62%. Most frequent signs present were empty uterine cavity, blob sign and embryo with or without cardiac activity.

Conclusion: TVS examination is quite effective in predicting and excluding ectopic pregnancy in early gestation. Majority of patients with ectopic pregnancy had surgery as part of their management.