The clinical and ultrasonic study of clinically suspected ectopic pregnancy: laying emphasis on 15 provenectopic pregnancies
10.3348/jkrs.1983.19.3.606
- Author:
Myung Ho BYUN
;
Yung Sun CHUNG
- Publication Type:Original Article
- MeSH:
Age Distribution;
Animals;
Dermoid Cyst;
Diagnosis;
Early Diagnosis;
Emergencies;
Female;
Fetal Heart;
Follow-Up Studies;
Gestational Sac;
Gynecology;
Hematoma;
Hemorrhage;
Laparoscopy;
Metrorrhagia;
Mice;
Myoma;
Myometrium;
Obstetrics;
Ovarian Cysts;
Pregnancy;
Pregnancy;
Pregnancy, Ectopic;
Pregnancy, Interstitial;
Pregnancy, Tubal;
Sterilization, Tubal;
Ultrasonics;
Ultrasonography;
Uterus;
Zygote
- From:Journal of the Korean Radiological Society
1983;19(3):606-615
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Ectopic pregnancies are unsuccessful pregnancies that result from implantation of fertilized ovum occurring inan aberrant area. Aside from an emergency case, the early diagnosis of ectopic pregnancy is very difficultparticularly in a case with insidious onset and mild clinical manifestations. Early diagnosis not only reduces thedanger, but also simplifies the management of ectopic pregnancy. Ultrasonography has been an indispensablediagnostic tool in obstetrics and Gynecology. In the authors' experience, clinical suspected ectopic pregnancy wasone of the common indications for performing ultrasonography. Since Kobayashi et al. reported the appearances ofextopic preganancy utilizing bistable B-scan ultrasonography, the ultrasonic findings of ectopic pregnancy havebeen reported by many authors. But, its accuracy and reliablity in the diagnosis of ectopic pregancy are stillopen to controversy. The authors studied 65 cases of clinically suspected ectopic pregnancy with Picker 80 L grayscale ultrasonography from Aug. 1982 to Jun. 1983. There were 29 confirmed cases, of which 15 were proved to haveextopic pregnancy and 14 were proved to have disease other than ectopic pregnancy by surgical andhistopathological study or by laparoscopy and histopatholoigcal study or by laparoscopy and follow up study. 29confirmed cases were reviewed. The resuls were as follows; 1. Among 15 ectopic pregnancies, there were 12ampullary pregnancies, 2 isthmic pregnancies and 1 interstitial pregancy. Among 14 cases of no ectopic pregnancy,there were 5 intrauterine pregnancies, 3 myoma uteri, 2 P.I.D., and 1 case of dermoid cyst, cystic teratoma,h-mole and tubal hematoma due to previous tubal ligation, respectively. 2. The age distribution of ectopicpregnancy was from 22 to 41 years. The common clinical manifestations of extopic pregnancy were lower abdominalpain (73.3%), vaginal spotting or bleeding (73.3%) and amenorrhea(66.7%). 3. Positive results of urine immunologicpregnancy test was 28.6% in ectopic pregnancy. 4. Ultrasonic findings of ectopic preganncy were as follows; 1) Nointrauterine gestational sac was observed in all cases except 1 interstitial pregnancy. Intrauterine fluidcollection was observed in 3 cases. Uterine displacement was observed in 10 cases. 2) Among 5 cases of rupturedtubal pregnancy, we observed predominantly cystic adnexal mass in 3 cases, mixed echogenic adnexal mass in 2cases, and cul-de-sac fluid in all cases. Among 9 cases of unruptured tubal pregnancy, we observed predominantlycystic adnexal mass in 2 cases, mixed echogenic adnexal mass in 7 cases, and cul-de- sac fluid in 3 cases. 3) Anechodense ring like structure was observed outside the uterus in 9 cases of tubal pregnancy. 4) In the case ofinterstitial pregnancy, eccentrically located gestational sac with overlying thin myometrium was observed withinthe uterus. 5) Fetal heart activity was noted outside the uterus with real time scanning in only 1 case of ectoicpregnancy. 5. Of 19 sonographically ectopic pregnancies, a correct positive ultrasonic diagnosis was made n 14cases (73.7%). Of 29 confirmed cases, overall diagnostic accuracy of ultrasound was 79.3%. 6. By demonstrationintrauterine pregnancy or disease other than ectopic pregnancy such as myoma uteri, homole or ovarian cyst,ectopic pregnancy was ultrasonically excluded in 10 cases. Among above 10 cases, 1 case of ultasonically bilateralovarian cyst was proved to have ruptured tubal pregnancy combined with ovarian cyst. The accuracy of ultrasonicexclusion of ectopic pregnancy was 90%. In the authors'experience, ultrasonography was very helpful in theexclusion of extopic pregnancy.
