Ectopic pregnancy poses a diagnostic and therapeutic challenge; however, advances in ultrasound technology and its applications have provided the capability to diagnose ectopic pregnancy at a very early stage. This article offers an update on the various specific and non-specific ultrasound diagnostic criteria used in the diagnosis of ectopic pregnancy.
BouyerJ, CosteJ, FernandezH, PoulyJL, Job-SpiraN.Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod2002; 17: 3224–30.
2.
RojanskyN, SchenkerJG.Heterotopic pregnancy and assisted reproduction: an update. J Assist Reprod Genet1996; 13: 594–601.
3.
O'HerlihyC.Centre for maternal and child enquiries (CMACE) Chapter 6: deaths in early pregnancy. BJOG2011; 118 (Suppl. 1): 1–203.
CosteJ, BouyerJ, UghettoS.Ectopic pregnancy is again on the increase. Recent trends in the incidence of ectopic pregnancies in France (1992-2002). Hum Reprod2004; 19: 2014–8.
6.
Confidential Enquiry into Maternal and Child Health (Formerly CEMACH, now CMACE).Saving mothers’ lives: reviewing maternal deaths to make motherhood safer - 2006-2008. The eighth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG2011; 118: 1–203.
7.
BolajiII, GuptaS.Medical management of interstitial pregnancy with high serum beta-selective human chorionic gonadotrophin. Ultrasound2010; 18: 60–7.
8.
BolajiII, TsakosE, SuganthaS.Tubal Pregnancy treated by Laparoscopic Intratubal Injection of Haemabate. In: Sixth Panhellenic Obstetrics and Gynaecology Conference, 23-27 November 1994, Caravel Hotel, Athens. Abstract 35; p 28
9.
LevineD.Review for residents: ectopic pregnancy. Radiology2007; 245: 385–97.
10.
CullenMT, GreenJJ, ReeceEA, HobbinsJC.A comparison of transvaginal and transabdominal ultrasound in visualising the first trimester conceptus. J Ultrasound Med1989; 8: 565–9.
11.
Centre for Evidence Based Medicine (CEBM) Oxford University. See http://www.cebm.net/index (last checked 14 March 2012)
12.
KirkE, PapageorghiouAT, CondousG, TanL, BoraS, BourneT.The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy. Hum Reprod2007; 22: 2824–8.
13.
Ofili-YeboviD, CassikP, LeeC, ElsonJ, HillabyK, JurkovicD.The efficacy of ultrasound-based protocol for the diagnosis of tubal ectopic pregnancy. Ultrasound Obstet Gynaecol2003; 22 (Suppl. 1): 1–69.
14.
RossavikIK, TorjusenGO, GibbonsWE.Conceptual age and ultrasound measurements of gestational sac and crown-rump length in in vitro fertilization pregnancies. Fertil Steril1988; 49: 1012–7.
15.
GoldsteinSR, WolfsonR.Endovaginal ultrasonographic measurement of early embryonic size as a means of assessing gestational age. J Ultrasound Med1994; 13: 27–31.
16.
TannirandornY, SangsawangS, ManotayaS.Fetal loss in threatened abortion after embryonic/fetal heart activity. Int J Gynecol Obstet2003; 81: 263–6.
17.
LopezHB, MicheelsenU, BerendtsenH, KockK.Ectopic pregnancy and its associated endometrial changes. Gynecol Obstet Invest1994; 38: 104–6.
18.
GoldsteinSR.Further attempts to refine our diagnostic capabilities in potential ectopic pregnancies. Ultrasound Obstet Gynecol1999; 14: 229–30.
19.
WachsbergRH, KarimiS.Sonographic endometrial three layer pattern in symptomatic first trimester pregnancy: not diagnostic of ectopic pregnancy. J Clin Ultrasound1998; 26: 199–201.
20.
HammoudAO, HammoudI, BujoldE, GonikB, DiamondMP, JohnsonSC.The role of sonographic endometrial patterns and endometrial thickness in the differential diagnosis of ectopic pregnancy. Am J Obstet Gynecol2005; 192: 1370–5.
21.
LavieO, BoldesR, NeumanM.Ultrasonographic ‘endometrial three layer’ pattern: a unique finding in ectopic pregnancy. J Clin Ultrasound1996; 24: 179–83.
LimJE, KimT, LeeN.Ultrasonographic endometrial features in tubal pregnancy: are they predictive factors of successful medical treatment?Ultrasound Med Biol2007; 33: 714–9.
YehHC.Efficacy of the intradecidual sign and fallacy of the double decidual sac sign in the diagnosis of early intrauterine pregnancy. Radiology1999; 210: 579–82.
26.
MarksWM, FillyRA, CallenPW, LaingFC.The decidual cast of early pregnancy: a confusing sonographic appearance. Radiology1979; 133: 451–4.
27.
HillLM, KislakS, MartinJG.Transvaginal sonographic detection of the pseudogestational sac associated with ectopic pregnancy. Obstet Gynaecol1990; 75: 986–8.
28.
FleischerAC, PennellRG, McKeeMS.Ectopic pregnancy: features at transvaginal sonography. Radiology1990; 174: 375–8.
29.
ThorsenMK, LawsonTL, AimanEJ.Diagnosis of ectopic pregnancy: endovaginal vs transabdominal sonography. AJR Am J Roentgenol1990; 155: 307–10.
30.
DoubiletPM, BensonCB.First do no harm to early pregnancies. J Ultrasound Med2010; 29: 685–9.
31.
YehHC, GoodmanJD, CarrL, RabinowitzJG.Intradecidual sign: a US criterion of early intrauterine pregnancy. Radiology1986; 161: 463–7.
32.
GuptaN, AngtuacoTL.Embryosonology in the first trimester of pregnancy. Ultrasound Clin2007; 2(2): 175–85.
33.
ChiangG, LevineD, SwireM, McNamaraA, MehtaT.The intradecidual sign: is it reliable for diagnosis of early intrauterine pregnancy?AJR Am J Roentgenol2004; 183: 725–31.
34.
LaingFC, BrownDL, PriceJF, TeegerS, WongML.Intradecidual sign: is it effective in diagnosis of an early intrauterine pregnancy?Radiology1997; 204: 655–60.
35.
BradleyWG, FiskeCE, FillyRA.The double sac sign of early intrauterine pregnancy: use in excision of ectopic pregnancy. Radiology1982; 143: 143–467.
36.
NybergDA, LaingFC, FillyRA, Uri-SimmonsM, JeffreyRBJr. Ultrasonographic differentiation of the gestational sac of early intrauterine pregnancy from the pseudogestational sac of ectopic pregnancy. Radiology1983; 146: 755–9.
37.
YenHC, Use of the double decidual sac sign and intradecidual sign *Reply, J Ultrasound Med2011; 30: 119–20.
AtriM, de StempelJ, BretPM.Accuracy of transvaginal ultrasonography for detection of hematosalpinx in ectopic pregnancy. J Clin Ultrasound1992; 20: 255–61.
40.
KirkE, BourneT.Diagnosis of ectopic pregnancy with ultrasound. Best Pract Res Clin Obstet Gynaecol2009; 23: 501–8.
41.
LinEP, BhattS, DoganVS.Diagnostic clues to ectopic pregnancy. Radiographics2008; 28: 1661–71.
42.
CondousG, OkaroE, KhalidA.The accuracy of transvaginal sonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod2005; 20: 1404–9.
43.
CoadyAM.Ectopic pregnancy: a review of sonographic diagnosis. Ultrasound2005; 13: 18–29.
44.
Timor-TritshIE, RottemS.Transvaginal ultrasonographic study of the fallopian tube. Obstet Gynecol1987; 70: 424–8.
45.
FratesMC, VisweswaranA, LaingFC.Comparison of tubal ring and corpus luteum echogenicities: a useful differentiating characteristic. J Ultrasound Med2001; 20: 27–31.
46.
SteinMW, RicciZJ, NovakL, RobertsJH, KoenigsbergM.Sonographic comparison of the tubal ring of ectopic pregnancy with the corpus luteum. J Ultrasound Med2004; 23: 57–62.
StabileI.Ectopic Pregnancy: Diagnosis and Management.New York, USA: Cambridge University Press1996: 55
49.
ShalevE, YaromI, BustanM, Ben-ShlomoI.Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases. Fertil Steril1998; 69: 62–5.
50.
JurkovicD, HacketE, CampbellS.Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively. Ultrasound Obstet Gynaecol1996; 8: 373–80.
51.
PelleritoJS, TaylorKJ, Quedens-CaseC.Ectopic pregnancy: evaluation with endovaginal color flow imaging. Radiology1992; 183: 407–11.
52.
BhattS, GhazaleH, DograVS.Sonographic evaluation of ectopic pregnancy. Radiol Clin North Am2007; 45: 549–60.
RussellSA, FillyRA, DamatoN.Sonographic diagnosis of ectopic pregnancy with endovaginal probes: what really has changed?J Ultrasound Med1993; 12: 145–51.
Timor-TritschIE, MonteagudoA, MateraC, VeitCR.Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol1992; 79: 1044–9.
57.
DuckmanS, AmicoJ.Cervical abortion; report of a case. Obstet Gynecol1957; 10: 240–3 [PubMed]
58.
BensonCB, DoubiletPM.Strategies for conservative treatment of cervical ectopic pregnancy. Ultrasound Obstet Gynecol1996; 8: 371–2.
59.
JurkovicD, MavrelosD.Catch me if you scan: ultrasound diagnosis of ectopic pregnancy. Ultrasound Obstet Gynecol2007; 30: 1–7.
60.
Timor-TritschIE, MonteagudoA, MandevilleEO, PeisnerDB, AnayaGP, PirroneEC.Successful management of viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography. Am J Obstet Gynecol1994; 170: 737–9.
61.
UshakovFB, ElchalalU, AcemanPJ, SchenkerJG.Cervical pregnancy: past and future. Obstet Gynaecol Surv1996; 52: 45–57.
62.
HoffmannHM, UrdlW, HoflerH.Cervical pregnancy: case reports and current concepts in diagnosis and treatment. Arch Gynecol Obstet1987; 241: 63–9.
MarretH, HamamahS, AlonsoAM, PierreF.Case report and review of the literature: primary twin ovarian pregnancy. Hum Reprod1997; 12: 1813–5.
72.
RojanskyN, SchenkerJG.Heterotopic pregnancy and assisted reproduction - an update. J Assist Reprod Genet1996; 13: 594–601.
73.
AtrashHK, FriedeA, HogueCJ.Abdominal pregnancy in the United States: frequency and maternal mortality. Obstet Gynecol1987; 69: 333–7.
74.
BelloGV, SchonholzD, MoshirpurJ, JengDY, BerkowitzRL.Combined pregnancy: the Mount Sinai experience. Obstet Gynecol Surv1986; 41: 603–13.
75.
RichardsSR, StempeLE, CarltonBD.Heterotopic pregnancy: reappraisal of incidence. Am J Obstet Gynecol1982; 142: 928–30.
76.
DeVoeRW, PrattJH.Simultaneous intra and extrauterine pregnancy. Am J Obstet Gynecol1948; 56: 1119
77.
FernandezH, GervaiseA.Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy. Hum Reprod Update2004; 10: 503–13.
78.
TamaiK, KoyamaT, TogashiK.MR features of ectopic pregnancy. Eur Radiol2007; 17: 3236–46. Epub 2007 Sep 20
79.
KataoakaM, TogashiK.Evaluation of ectopic pregnancy by magnetic resonance imaging. Hum Reprod1999; 14: 2644–50.
80.
FilhastreM, DechaudH, LesnikA, TaourelP.Interstitial pregnancy: role of MRI. Eur Radiol2005; 15: 93–5. Epub 2004 May 7
81.
PedrosaI, ZeikusE.MR Imaging of acute right lower quadrant pain in pregnant and nonpregnant patients. Radiographics2007; 27: 721–43.
82.
PaspulatiRM, BhattS.Sonographic evaluation of first-trimester bleeding. Radiol Clin North Am2004; 42: 297–314.
83.
BrownDL, FelkerRE, StovallTG, EmersonDS, LingFW.Serial endovaginal sonography of ectopic pregnancies treated with methotrexate. Obstet Gyneacol1991; 77: 406–9.
84.
American College of Obstetricians and Gynaecologists.Medical Management of Tubal Pregnancy. ACOG Practice Bulletin 3.Washington, DC: American College of Obstetricians and Gynaecologists, 1998
85.
de BoerCN, van DongenPW, WillemsenWN, KlapwijkCW.Ultrasound diagnosis of interstitial pregnancy. Eur J Obstet Gynecol Reprod Biol1992; 47: 164–6.