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The effect of morphological types of extrauterine ectopic pregnancies on the accuracy of pre-operative ultrasound diagnosis

W M Dooley, P Chaggar, L V De Braud, C Bottomley, E Jauniaux, D Jurkovic
Ultrasound in Obstetrics & Gynecology 2019 April 1

OBJECTIVES: The aim of this study was to assess the overall accuracy of the transvaginal ultrasound scan (TVS) diagnosis of all types of extrauterine ectopic pregnancy (EUEP) in a large group of women who were managed surgically. We also examined the positive predictive value (PPV) of the different ultrasound morphological types of EUEP, using visual confirmation of ectopic pregnancy on surgery as the reference standard.

METHODS: We performed a retrospective observational study of all pregnant women who underwent emergency surgery following ultrasound diagnosis of EUEP in a single Early Pregnancy Unit between January 2009 and December 2017. The pre-operative TVS findings were recorded including the exact location and morphological type (defined on ultrasound criteria, as type I-V) of EUEP. The TVS findings were compared with the operative and histological findings.

RESULTS: A total of 26401 women presented with early pregnancy complications during the study period, including 1241 (4.7%, 95% CI 4.5-5.0) women who were diagnosed with an EUEP. Surgery was performed in 721 cases (58.1%, 95% CI 55.3-60.8) out of which 710 (98.5%, 95%CI 97.6% to 99.4%) had been diagnosed with an EUEP on a preoperative TVS. The remaining 11 women had severe pain and significant haemoperitoneum and were managed surgically on clinical grounds as an emergency, without an ectopic pregnancy having been identified on ultrasound scan. At laparoscopy the diagnosis of EUEP was confirmed in 706/710 (99.4%, 95% CI 98.6-99.8) of women with positive ultrasound diagnosis and in all 11 women with presumed ultrasound diagnosis of EUEP. The PPV of pre-operative ultrasound for the diagnosis of EUEP was 99.4% (95% CI 98.6-99.8) with a sensitivity of 98.5% (95% CI 97.3-99.1). There was no statistically significant difference in the accuracy of pre-operative ultrasound diagnosis for the five morphological types of EUEP (p=0.76).

CONCLUSIONS: The accuracy of pre-operative ultrasound diagnosis of EUEP is high. The morphological type of EUEP on TVS had no significant effect on the accuracy of pre-operative diagnosis. This article is protected by copyright. All rights reserved.


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