Rajah, K;
Goodhart, V;
Zamora, KP;
Amin, T;
Jauniaux, E;
Jurkovic, D;
(2018)
How to measure size of tubal ectopic pregnancy on ultrasound.
Ultrasound in Obstetrics & Gynecology
, 52
(1)
pp. 103-109.
10.1002/uog.18958.
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Abstract
OBJECTIVE: To identify the preoperative ultrasound measurements for assessing the size of tubal ectopic pregnancy which correlate best with the findings at surgery. METHODS: We conducted a prospective study of all women with a conclusive transvaginal ultrasound diagnosis of tubal ectopic pregnancy over a 10-month period. In each case, we measured the total size of the ectopic pregnancy by placing the calipers on the outer edges of the visible trophoblastic tissue. In ectopic pregnancies, presenting with a well-defined gestational sac we also measured the size of coelomic (chorionic) cavity using the inner borders of the trophoblastic ring as the reference points. In women with signs of intraabdominal bleeding, we measured the size of the haematosalpinx and haemoperitoneum. The surgeons were blinded to the ultrasound measurements and they were asked to estimate the size of the ectopic pregnancy and the amount of haemoperitoneum intraoperatively. RESULTS: A total of 105 women were diagnosed with a tubal ectopic pregnancy on ultrasound examination out of which 71/105 (67.6%) were managed surgically. We found a significant (p<0.01) positive correlation between all ultrasound measurements and the size of tubal ectopic pregnancy as reported during surgery. In the absence of a haematosalpinx, the mean total outer diameter of ectopic pregnancy had the highest positive correlation with the size of tubal ectopic at surgery (r=0.65, P<0.001). In cases complicated by haematosalpinx, the mean diameter of the tube was the only variable which correlated significantly (p<0.001) with the estimated size of ectopic pregnancy at surgery. There was a significant (p<0.001) positive association between the amount of haemoperitoneum on ultrasound and the estimated volume of intraperitoneal blood at surgery. CONCLUSION: The mean size of haematosalpinx and the total outer mean dimeter of ectopic pregnancy on ultrasound correlate better with the surgical findings than the size of coelomic cavity. Our findings show that the standard approach to measure the size of intrauterine pregnancy on ultrasound should be adapted in women diagnosed with tubal ectopic pregnancies to include these additional measurements.
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