Diagnostic performance of transvesical ultrasound in clinically suspected ectopic pregnancy in a public and tertiary hospital setup.

BACKGROUND: Ectopic pregnancy consists 1.2 to 1.4% of all reported pregnancies and an increasing accordance has been documented in many parts of the world

OBJECTIVE: To evaluate the performance of transvesical ultrasound (TVS) in the diagnosis of ectopic pregnancy in the public hospital setup.

METHODS: Review of medical records of 117 patients who were admitted to St Paul's Hospital with the diagnosis of ectopic pregnancy between the years 2005 and 2008 was made. Data on demographic & clinical information, and laboratory investigations done and transvesical ultrasound records were collected. Outcomes after Laparatomy were used as confirmations or gold standard for final diagnosis.

RESULTS: Of the 117 admitted patients for ectopic pregnancy, 99 (84.6%) had transvesical ultrasound done & in 65 (65.9%) of those 99 patients, it suggested diagnosis of ectopic pregnancy. Sixty-four (55%) had pervaginal bleeding and lower abdominal pain as presenting complaint. Documentation of uterine, adnexal & cul-de-sac findings fall the three diagnostic variables) was noted in 71/99 (71.7%) two of the three and only one of the three diagnostic variables were seen 20.2% and 8.1% of the sonographic studies respectively. Of patients whose ultrasound report suggested ectopic pregnancy, in 46 (70.8%) a complex adnexal mass and in 33 (50.8%) moderate to large amount of cul-de-sac fluid, and in 9 (19.8%) patients fluid in the uterine cavity were detected The overall sensitivity and specificity of transvesical ultrasound study in the diagnosis of ectopic pregnancy were 83.3% and 33.3% respectively, with positive & negative predictive values of 73.5% and 47.4% respectively and accuracy of 68%.

CONCLUSION: About 83.3% of admitted patients were diagnosed sonographically to have ectopic gestation prior to surgery. Quality of the ultrasound report with respect to completeness in number of sonographic diagnostic variables has a statistically significant (P < 0.05) role in enhancing the accuracy of transvesical ultrasonography in the diagnosis and exclusion of ectopic pregnancy.