Article: Chu RR, Liu DF, Wang M, Liu L. Ultrasonographic diagnosis of early unruptured tubal pregnancy in a community hospital. J Int Med Res. 2020 May;48(5):300060519894436. doi: 10.1177/0300060519894436. PMID: 32374206; PMCID: PMC7221168.
Background: Ectopic pregnancy is a common gynecologic emergency, accounting for 2% of all pregnancies. Of these, 95-98% of them occurring in the fallopian tubes. It must be considered when a serum or urine pregnancy test is positive and no pregnancy is found in utero. It is important to detect ectopic pregnancy early and accurately to prevent eventual rupture, hemorrhage, shock, and possibly death. This study aimed to identify ultrasonographic characteristics and diagnostic approaches of unruptured tubal pregnancy (UTP), to better detect UTP and thus prevent exceeding the limited resource availability in the community hospital setting.
Methods:
· Design: Retrospective Observational Study of unruptured tubal ectopic pregnancies at a single hospital in Shanghai, China.
· Inclusion Criteria: All patients with a tubal pregnancy from January 2011 to December 2018 and were positive on urine pregnancy testing
· Ultrasound Technique: Abdominal or transvaginal ultrasound
· Analyzed Ultrasonographic Characteristics:
o Bilateral accessory area: Presence of a mass, the mass’s relationship to the fallopian tube, if the mass had blood flow, and if there was fallopian tube thickening
o Uterine Intimal Echogenicity
o Presence of real pregnancy sac or pseudopregnancy sac
Results
· Cases:
o 146 cases of UTP. Of these, 89.04% (130) were diagnosed by ultrasound with a missed diagnostic rate of 10.96% (16).
o A total of three of these cases were misdiagnosed by transabdominal US.
· Key Ultrasonographic Characteristics
o Ipsilateral Tubal Thickening: 48% of patients
o Intimal Thickness: 67.80% of cases were ≤ 10 mm
o Intimal Echo Characteristics: 72.60% high echo, 15.07% medium echo, 4.79% low echo
o Mass: 40% were embryo sac type while 60% were heterogenous Para-ovarian masses
o Blood Flow: 68% of patients did not have any observed blood flow in or around the mass
Limitations
· The specialty of the provider performing the ultrasound was unknown, though the provider had ≥5 years of experience in gynecologic ultrasound.
· Unknown the number of transvaginal versus transabdominal ultrasounds in this study
· No statistical analysis performed. Results reported only as prevalence of ultrasonographic findings.
Author’s Conclusion: A Paraovarian mass, thickened fallopian tube, uterine endometrium with a thickness of ≤ 10 mm, and high echo are important indicators of early tubal pregnancy.
Bottom Line: This retrospective observational study outlined ultrasonographic characteristics that may be important to the early diagnosis of early UTP. However, until these are validated in a trial and statistical analysis conducted, and perhaps evaluated in the ED context, radiology transvaginal ultrasonography should continue to be utilized in the diagnosis of suspected ectopic pregnancy
Author: Dillon Warr, MD