Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
Ectopic pregnancy continues to be a major cause of maternal morbidity and mortality . A dramatic increase in incidence over time has been reported in several countries. The advent and wide application of ultrasound has greately improved the possibility of non- surgical diagnosis of ectopic pregnancy . Images obtained by the higher frequency and better resolution transvaginal ultrasound scan (TVS) probes facilitates the earlier diagnosis of ectopic pregnancy. The addition of Doppler ultrasound have revolutionised the non-invasive diagnosis of ectopic pregnancy.
METHODS:
Patients presenting to Al-Yarmouk Teaching Hospital with clinical suspicion of ectopic pregnancy were evaluated using TVUS. Colour flow imaging was performed and resistance indices (RIs) of the artery blood flow were calculated . The pulsatility indices (PIs) of both uterine arteries were also measured and serum β-hCG was quantitated . The Doppler flow results were correlated with surgical findings at laparoscopy or explorative laparotomy .
RESULTS:
Forty-seven women were enrolled .Six patients with intrauterine gestation were excluded . Tubal pregnancy was diagnosed by TVUS in 28 of 32 patients with ectopic pregnancy, while 30 of 32 patients were diagnosed by colour Doppler sonography. Colour flow in the trophoblastic tissue was detected in 59.3% of the tubal pregnancies, and the mean (±SD) RI of the trophoblastic flow was (0.49 ±0.1) . The RIs tended to decrease at higher β- hCG levels. The average PI of the uterine arteries was (2.29 ± 0.3) . The PIs of the ipsilateral uterine arteries were significantly lower than the contralateral ones. The sensitivity of colour Doppler in the diagnosis of ectopic pregnancy was (93.8%) with accuracy of (85.4%)
CONCLUSION:
Colour imaging is a good supplementary diagnostic tool in modern management of ectopic pregnancy . The addition of colour Doppler flow imaging to transvaginal sonography allows increased sensitivity in the detection of ectopic pregnancy.