Advertisement

Abdominal Radiology

, Volume 42, Issue 5, pp 1524–1542 | Cite as

Pitfalls and tips in the diagnosis of ectopic pregnancy

  • E. Mausner Geffen
  • C. Slywotzky
  • G. Bennett
Pictorial Essay

Abstract

Women of reproductive age with pelvic pain, vaginal bleeding, and a positive pregnancy test often require evaluation with pelvic ultrasound. In these situations, the primary role of pelvic ultrasound is to differentiate an ectopic pregnancy from either a normal or abnormal intrauterine pregnancy. While an accurately performed and interpreted pelvic ultrasound results in rapid diagnosis and management, numerous diagnostic pitfalls can lead to negative outcomes. Therefore, familiarity with the appropriate laboratory tests, sonographic technique, and imaging features of ectopic pregnancy is essential for all radiologists. We present a review of ectopic pregnancy cases from our institution with attention to common pitfalls and troubleshooting tips for physicians who perform and interpret pelvic ultrasounds. We also present recently published literature to aid in the management of first trimester pregnancy.

Keywords

Ectopic pregnancy Pregnancy of unknown location Human chorionic gonadotropin (HCG) 

Notes

Compliance with ethical standards

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Statement of informed consent was not applicable since the manuscript does not contain any patient data.

References

  1. 1.
    Barnhart KT (2009) Clinical practice. Ectopic pregnancy. N Engl J Med 361(4):379–387. doi: 10.1056/NEJMcp0810384 CrossRefPubMedGoogle Scholar
  2. 2.
    Dialani V, Levine D (2004) Ectopic pregnancy: a review. Ultrasound Q 20(3):105–117CrossRefGoogle Scholar
  3. 3.
    Levine D (2007) Ectopic pregnancy. Radiology 245(2):385–397. doi: 10.1148/radiol.2452061031 CrossRefPubMedGoogle Scholar
  4. 4.
    Barnhart K, van Mello NM, Bourne T, et al. (2011) Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. Fertil Steril 95(3):857–866. doi: 10.1016/j.fertnstert.2010.09.006 CrossRefPubMedGoogle Scholar
  5. 5.
    Doubilet PM, Benson CB (2011) Further evidence against the reliability of the human chorionic gonadotropin discriminatory level. J Ultrasound Med 30(12):1637–1642CrossRefGoogle Scholar
  6. 6.
    Doubilet PM, Benson CB, Bourne T, et al. (2013) Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 369(15):1443–1451. doi: 10.1056/NEJMra1302417 CrossRefGoogle Scholar
  7. 7.
    Tenore JL (2000) Ectopic pregnancy. Am Fam Physician 61(4):1080–1088PubMedGoogle Scholar
  8. 8.
    American College of Obstetricians and Gynecologists (2008) ACOG Practice Bulletin No. 94: medical management of ectopic pregnancy. Obstet Gynecol 111(6):1479–1485. doi: 10.1097/AOG.0b013e31817d201e CrossRefGoogle Scholar
  9. 9.
    Zinn HL, Cohen HL, Zinn DL (1997) Ultrasonographic diagnosis of ectopic pregnancy: importance of transabdominal imaging. J Ultrasound Med 16(9):603–607CrossRefGoogle Scholar
  10. 10.
    Worley KC, Hnat MD, Cunningham FG (2008) Advanced extrauterine pregnancy: diagnostic and therapeutic challenges. Am J Obstet Gynecol 198(3):e291–e297. doi: 10.1016/j.ajog.2007.09.044 CrossRefGoogle Scholar
  11. 11.
    Chiang G, Levine D, Swire M, McNamara A, Mehta T (2004) The intradecidual sign: is it reliable for diagnosis of early intrauterine pregnancy? AJR Am J Roentgenol 183(3):725–731. doi: 10.2214/ajr.183.3.1830725 CrossRefPubMedGoogle Scholar
  12. 12.
    Doubilet PM, Benson CB (2013) Double sac sign and intradecidual sign in early pregnancy: interobserver reliability and frequency of occurrence. J Ultrasound Med 32(7):1207–1214. doi: 10.7863/ultra.32.7.1207 CrossRefPubMedGoogle Scholar
  13. 13.
    Doubilet PM, Benson CB (2010) First, do no harm… To early pregnancies. J Ultrasound Med 29(5):685–689CrossRefGoogle Scholar
  14. 14.
    Lin EP, Bhatt S, Dogra VS (2008) Diagnostic clues to ectopic pregnancy. Radiographics 28(6):1661–1671. doi: 10.1148/rg.286085506 CrossRefPubMedGoogle Scholar
  15. 15.
    Benson CB, Doubilet PM, Peters HE, Frates MC (2013) Intrauterine fluid with ectopic pregnancy: a reappraisal. J Ultrasound Med 32(3):389–393CrossRefGoogle Scholar
  16. 16.
    Frates MC, Doubilet PM, Peters HE, Benson CB (2014) Adnexal sonographic findings in ectopic pregnancy and their correlation with tubal rupture and human chorionic gonadotropin levels. J Ultrasound Med 33(4):697–703. doi: 10.7863/ultra.33.4.697 CrossRefPubMedGoogle Scholar
  17. 17.
    Frates MC, Visweswaran A, Laing FC (2001) Comparison of tubal ring and corpus luteum echogenicities: a useful differentiating characteristic. J Ultrasound Med 20(1):27–31; quiz 33CrossRefGoogle Scholar
  18. 18.
    Jurkovic D, Hacket E, Campbell S (1996) Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively. Ultrasound Obstet Gynecol 8(6):373–380. doi: 10.1046/j.1469-0705.1997.08060373.x CrossRefPubMedGoogle Scholar
  19. 19.
    Malinowski A, Bates SK (2006) Semantics and pitfalls in the diagnosis of cornual/interstitial pregnancy. Fertil Steril 86(6):e1711–e1764. doi: 10.1016/j.fertnstert.2006.03.073 CrossRefGoogle Scholar
  20. 20.
    Timor-Tritsch IE, Monteagudo A, Matera C, Veit CR (1992) Sonographic evolution of cornual pregnancies treated without surgery. Obstet Gynecol 79(6):1044–1049PubMedGoogle Scholar
  21. 21.
    Ackerman TE, Levi CS, Dashefsky SM, Holt SC, Lindsay DJ (1993) Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology 189(1):83–87. doi: 10.1148/radiology.189.1.8372223 CrossRefPubMedGoogle Scholar
  22. 22.
    Kung FT, Lin H, Hsu TY, et al. (2004) Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection. Fertil Steril 81(6):1642–1649. doi: 10.1016/j.fertnstert.2003.11.034 CrossRefPubMedGoogle Scholar
  23. 23.
    Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ (2015) Births: final data for 2013. Natl Vital Stat Rep 64(1):1–65PubMedGoogle Scholar
  24. 24.
    Ash A, Smith A, Maxwell D (2007) Caesarean scar pregnancy. BJOG 114(3):253–263. doi: 10.1111/j.1471-0528.2006.01237.x CrossRefPubMedGoogle Scholar
  25. 25.
    Timor-Tritsch IE, Monteagudo A, Cali G, et al. (2014) Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound Obstet Gynecol 44(3):346–353. doi: 10.1002/uog.13426 CrossRefPubMedGoogle Scholar
  26. 26.
    Gerli S, Rossetti D, Baiocchi G, et al. (2004) Early ultrasonographic diagnosis and laparoscopic treatment of abdominal pregnancy. Eur J Obstet Gynecol Reprod Biol 113(1):103–105. doi: 10.1016/S0301-2115(03)00366-X CrossRefPubMedGoogle Scholar
  27. 27.
    Fernandez H, Gervaise A (2004) Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy. Hum Reprod Update 10(6):503–513. doi: 10.1093/humupd/dmh043 CrossRefPubMedGoogle Scholar
  28. 28.
    Chang FW, Chen CH, Liu JY (2004) Early diagnosis of ovarian pregnancy by ultrasound. Int J Gynaecol Obstet 85(2):186–187. doi: 10.1016/j.ijgo.2003.11.006 CrossRefPubMedGoogle Scholar
  29. 29.
    Angtuaco TL, Shah HR, Mattison DR, Quirk JG Jr (1992) MR imaging in high-risk obstetric patients: a valuable complement to US. Radiographics 12(1):91–109; discussion 110. doi: 10.1148/radiographics.12.1.1734485 CrossRefGoogle Scholar
  30. 30.
    Izquierdo LA, Nicholas MC (2003) Three-dimensional transvaginal sonography of interstitial pregnancy. J Clin Ultrasound (JCU) 31(9):484–487. doi: 10.1002/jcu.10201 CrossRefGoogle Scholar
  31. 31.
    Sherer DM, Gorelick C, Dalloul M, et al. (2008) Three-dimensional sonographic findings of a cervical pregnancy. J Ultrasound Med 27(1):155–158CrossRefGoogle Scholar
  32. 32.
    Shih JC (2004) Cesarean scar pregnancy: diagnosis with three-dimensional (3D) ultrasound and 3D power Doppler. Ultrasound Obstet Gynecol 23(3):306–307. doi: 10.1002/uog.1000 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of RadiologyNYU Langone Medical CenterNew YorkUSA

Personalised recommendations