Effect of morphological type of extrauterine ectopic pregnancy on accuracy of preoperative ultrasound diagnosis.
Adult
Female
Hemoperitoneum
/ diagnosis
Humans
Laparoscopy
/ methods
Middle Aged
Pelvic Pain
/ diagnosis
Predictive Value of Tests
Pregnancy
Pregnancy Complications
/ epidemiology
Pregnancy, Ectopic
/ diagnostic imaging
Preoperative Period
Retrospective Studies
Sensitivity and Specificity
Ultrasonography
/ methods
diagnostic imaging
ectopic
first-trimester pregnancy
pregnancy
ultrasonography
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
09
11
2018
revised:
01
03
2019
accepted:
23
03
2019
pubmed:
3
4
2019
medline:
17
3
2020
entrez:
3
4
2019
Statut:
ppublish
Résumé
To assess the overall accuracy of transvaginal ultrasound (TVS) for diagnosis of all types of extrauterine ectopic pregnancy (EUEP) in a large group of women who were managed surgically. We also aimed to assess the positive predictive value (PPV) of TVS for each of the different ultrasound morphological types of EUEP. This was a retrospective observational study of all pregnant women who underwent emergency surgery following ultrasound diagnosis of EUEP at a single early pregnancy unit between January 2009 and December 2017. The preoperative TVS findings were recorded, including the exact location and morphological type (Type I-V; defined using ultrasound criteria) of EUEP. TVS findings were compared with operative and histological findings. The performance of ultrasound in diagnosing EUEP overall and according to morphological type was assessed, using visual confirmation of ectopic pregnancy at surgery as the reference standard. A total of 26 401 women presented with early-pregnancy complications during the study period, including 1241 (4.7%; 95% CI, 4.5-5.0%) women with a conclusive diagnosis of EUEP on TVS or a presumed diagnosis based on severe pain and significant hemoperitoneum. Surgery was performed in 721/1241 (58.1%; 95% CI, 55.3-60.8%) cases, of which 710 (98.5%; 95% CI, 97.6-99.4%) had a conclusive diagnosis of EUEP on preoperative TVS. The remaining 11 women had severe pain and significant hemoperitoneum and were managed surgically on clinical grounds as an emergency, without an ectopic pregnancy having been identified on ultrasound examination. At laparoscopy, the diagnosis of EUEP was confirmed in 706/710 (99.4%; 95% CI, 98.6-99.8%) women with a positive ultrasound diagnosis and in all 11 women with a presumed ultrasound diagnosis of EUEP. The PPV of preoperative ultrasound for the diagnosis of EUEP was 99.4% (95% CI, 98.6-99.8%) with sensitivity of 98.5% (95% CI, 97.3-99.1%). There was no statistically significant difference in the accuracy of preoperative ultrasound diagnosis between the five morphological types (P = 0.76). The accuracy of preoperative ultrasound for diagnosis of EUEP is high. The morphological type of EUEP on TVS had no significant effect on the accuracy of preoperative diagnosis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Types de publication
Comparative Study
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
538-544Informations de copyright
Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Références
Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D, Harper A, Hulbert D, Lucas S, McClure J, Millward-Sadler H, Neilson J, Nelson-Piercy C, Norman J, O'Herlihy C, Oates M, Shakespeare J, de Swiet M, Williamson C, Beale V, Knight M, Lennox C, Miller A, Parmar D, Rogers J, Springett A. Saving Mothers' Lives: Reviewing Maternal Deaths To Make Motherhood Safer: 2006-2008. BJOG 2011; 118: 81-84.
Diagnosis and management of ectopic pregnancy: Green Top Guideline. BJOG 2016; 123: 15-55.
Mavrelos D, Nicks H, Jamil A, Hoo W, Jauniaux E, Jurkovic D. Efficacy and safety of a clinical protocol for expectant management of selected women diagnosed with a tubal ectopic pregnancy. Ultrasound Obstet Gynecol 2013; 42: 102-107.
Jauniaux E, Jurkovic D. Ectopic pregnancy: 130 years of medical diagnostic challenges. BJOG 2018; 125: 1672.
Beck P, Broslovsky L, Gal D, Tancer ML. The role of laparoscopy in the diagnosis of ectopic pregnancy: a plea for conservative management. Int J Gynaecol Obstet 1984; 22: 307-309.
Sowter M, Farquhar CM. Ectopic pregnancy: An update. Curr Opin Obstet Gynecol 2004; 16: 289-293.
Kobayashi M, Hellman LM, Fillisti LP. Ultrasound: An aid in the diagnosis of ectopic pregnancy. Am J Obstet Gynecol 1969; 103: 1131-1140.
Brown D, Doubilet P. Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics. J Ultrasound Med 1994; 13: 259-266.
Kirk E, Papageorghiou AT, Condous G, Tan L, Bora S, Bourne T. The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy. Hum Reprod 2007; 22: 2824-2828.
Bignardi T, Alhamdan D, Condous G. Is ultrasound the new gold standard for the diagnosis of ectopic pregnancy? Semin Ultrasound CT MR 2008; 29: 114-120.
Casikar I, Reid S, Condous G. Ectopic pregnancy: Ultrasound diagnosis in modern management. Clin Obstet Gynecol 2012; 55: 402-409.
Cacciatore B, Stenman U, Ylöstalo P. Diagnosis of ectopic pregnancy by vaginal ultrasonography in combination with a discriminatory serum hCG level of 1000 IU/L. Br J Obstet Gynaecol 1990; 97: 904-908.
Kadar N, DeVore G, Romero R. Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy. Obstet Gynecol 1981; 58: 156-161.
Nadim B, Infante F, Lu C, Sathasivam N, Condous G. Morphological ultrasound types known as ‘blob’ and ‘bagel’ signs should be reclassified from suggesting probable to indicating definite tubal ectopic pregnancy. Ultrasound Obstet Gynecol 2018; 51: 543-549.
Education and Practical Standards Committee, European Federation of Societies for Ultrasound in Medicine and Biology. Minimum training recommendations for the practice of medical ultrasound. Ultraschall Med 2006; 27: 79-105.
Rajah K, Goodhart V, Zamora K, Amin T, Jauniaux E, Jurkovic D. How to measure size of tubal ectopic pregnancy on ultrasound. Ultrasound Obstet Gynecol 2018; 52: 103-109.
Jurkovic D, Mavrelos D. Catch me if you scan: Ultrasound diagnosis of ectopic pregnancy. Ultrasound Obstet Gynecol 2007; 30: 1-7.
Barnhart K, van Mello NM, Bourne T, Kirk E, Van Calster B, Bottomley C, Chung K, Condous G, Goldstein S, Hajenius PJ, Mol BW, Molinaro T, O'Flynn O'Brien KL, Husicka R, Sammel M, Timmerman D. Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. Fertil Steril 2011; 95: 857-866.
Damario MA, Rock JA. Ectopic Pregnancy. In Te Linde's Operative Gynaecology, Rock JA, Jones HW (eds). Lippincott Williams & Wilkins: Philadelphia, 2008; 798-823.
Condous G, Okaro E, Khalid A, Lu C, Huffel S, Timmerman D, Bourne T. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod 2005; 20: 1404-1409.
Lattouf I, Lu C, Pixton S, Reid S, Condous G. Is there a difference in the behaviour and subsequent management of ectopic pregnancies seen at first scan compared to those ectopic pregnancies which commence as pregnancies of unknown location? Aust N Z J Obstet Gynaecol 2016; 56: 107-112.
Farahani L, Sinha A, Lloyd J, Islam M, Ross JA. Negative histology with surgically treated tubal ectopic pregnancies - A retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2017; 213: 98-101.
Meys EM, Kaijser J, Kruitwagen RF, Slangen BF, Van Calster B, Aertgeerts B, Verbakel JY, Timmerman D, Van Gorp T. Subjective assessment versus ultrasound models to diagnose ovarian cancer: A systematic review and meta-analysis. Eur J Cancer 2016; 58: 17-29.