Ultrasound Evaluation of Ectopic Pregnancy

  • Donald L. Fylstra


Ectopic pregnancy, the implantation of a fertilized ovum outside the uterine cavity, now accounts for 2 % of all pregnancies in the United States. Nearly all ectopic pregnancies (97 %) are implanted within the fallopian tube, and a common factor for the development of such ectopics is the presence of a pathological fallopian tube. Ectopic implantation can also occur outside of the fallopian tube, within the cervix, ovary, abdomen, uterine cornua, and cesarean scars. These extratubal implantations may not be associated with tubal pathology or the expected preexisting risk factors for tubal ectopic implantation. The imaging modality of choice for the diagnosis of early pregnancy, regardless of implantation site, is transvaginal ultrasound. Early transvaginal ultrasound can locate most, if not all early pregnancies, and should be performed on every early pregnancy with symptoms of gestational pathology or a high likelihood of ectopic pregnancy based on gynecologic history.


Fallopian Tube Ectopic Pregnancy Endometrial Cavity Intrauterine Pregnancy Cesarean Scar 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Centers for Disease Control and Prevention (CDC). MMWR. Ectopic pregnancy – United States, 1990–1992. MMWR Morb Mortal Wkly Rep. 1995;44:46–8.Google Scholar
  2. 2.
    Ankum WM, Mol BWJ, Van der Veen F, Bodduyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65:1093–9.PubMedGoogle Scholar
  3. 3.
    Peterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J. The risk of ectopic pregnancy after tubal sterilization: US Collaborative Review of Sterilization Working Group. N Engl J Med. 1997;336:762–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Borgatta L, Murphy M, Chuangb C, Beardsley L, Burnhill MS. Pregnancies diagnosed during depo-provera use. Contraception. 2002;66:169–72.PubMedCrossRefGoogle Scholar
  5. 5.
    Furlong LA. Ectopic pregnancy risk when conception fails: a review. J Reprod Med. 2002;47:881–5.PubMedGoogle Scholar
  6. 6.
    Kadar N, Bohrer M, Kemmann E, et al. The discriminatory human chorionic gonadotropin zone for endovaginal sonography: a prospective, randomized study. Fertil Steril. 1994;61:1016–20.PubMedGoogle Scholar
  7. 7.
    Spandorfer SD, Barnhart KT. Endometrial stripe thickness as a predictor of ectopic pregnancy. Fertil Steril. 1996;66:474–7.PubMedGoogle Scholar
  8. 8.
    Ankum WM, Van der Veen F, Hamerlynck JVTH, et al. What to do when human chorionic gonadotropin levels are below the discriminatory zone. J Reprod Med. 1995;40:525–8.PubMedGoogle Scholar
  9. 9.
    Barnhart KT, Sammel MD, Rinaudo PF, Zhou L, Hummel AC, Guo W. Symptomatic patients with an early viable intrauterine pregnancy: HCG curves redefined. Obstet Gynecol. 2004;104:50–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Kadar N, Caldwell BV, Romero R. A method of screening for ectopic pregnancy and its indications. Obstet Gynecol. 1981;52:162–6.Google Scholar
  11. 11.
    Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N. Site of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod. 2002;17:3224–30.PubMedCrossRefGoogle Scholar
  12. 12.
    Ushakov FB, Elchalal U, Aceman PJ, Schenker JG. Cervical pregnancy: past and future. Obstet Gynecol Surv. 1997;52:45–59.PubMedCrossRefGoogle Scholar
  13. 13.
    Dicker D, Feldberg D, Samuel N, Goldman JA. Etiology of cervical pregnancy: association with abortion, pelvic pathology, IUDs, and Asherman’s syndrome. J Reprod Med. 1985;30:25–7.PubMedGoogle Scholar
  14. 14.
    Ginsburg ES, Frates MC, Rein MS, Fox JH, Hornstein MD, Friedman AJ. Early diagnosis and treatment of cervical pregnancy in an in vitro fertilization program. Fertil Steril. 1994;61:966–9.PubMedGoogle Scholar
  15. 15.
    Shinagawa S, Nagayama M. Cervical pregnancy as a possible sequela of induced abortion. Am J Obstet Gynecol. 1969;105:282–4.PubMedGoogle Scholar
  16. 16.
    Thomas RL, Gingold BR, Gallagher MW. Cervical pregnancy: a report of two cases. J Reprod Med. 1991;36:459–62.PubMedGoogle Scholar
  17. 17.
    Raskin MM. Diagnosis of cervical pregnancy by ultrasound: a case report. Am J Obstet Gynecol. 1978;130:234–5.PubMedGoogle Scholar
  18. 18.
    Timor-Tritsch IE, Monteagurdo A, Mandeville EO, Peisner DB, Anaya GP, Pirronw EC. Successful management of a viable cervical pregnancy by local injection of methotrexate guided by transvaginal ultrasonography. Am J Obstet Gynecol. 1994;170:737–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Grimes HG, Nosal RA, Gallagher JC. Ovarian pregnancy: a series of 24 cases. Obstet Gynecol. 1983;61:174–80.PubMedGoogle Scholar
  20. 20.
    Kraemer B, Kraemer E, Guengoer E, Juhasz-Boess I, Solomayer EF, Wallwiener D, Rajad TK. Ovarian ectopic pregnancy: diagnosis, treatment, correlation to Carnegie Stage 16 and review based on a clinical case. Fertil Steril. 2009;92:392. e13–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Sandvei R, Ulstein M. History and finding of ectopic pregnancies in women with and without an IUD. Contracept Deliv Syst. 1980;1:131–8.PubMedGoogle Scholar
  22. 22.
    Spiegelberg O. Zur Casuistik der Ovariaschwangerschaft. Arch Gynakol. 1873;13:73.CrossRefGoogle Scholar
  23. 23.
    Shaw SW, Hsu JJ, Chueh HY, Han CM, Chen FC, Chang YL, Chao AS, Cheng PJ, Hsieh TT, Soong YK. Management of primary abdominal pregnancy: twelve years of experience in a medical centre. Acta Obstet Gynacol. 2007;86:1058–62.CrossRefGoogle Scholar
  24. 24.
    Clark JFJ, Guy RS. Abdominal pregnancy. Am J Obstet Gynecol. 1996;96:511–20.Google Scholar
  25. 25.
    Studdiford WE. Primary peritoneal pregnancy. Am J Obstet Gynecol. 1942;44:487–91.Google Scholar
  26. 26.
    Anderson PM, Opfer EK, Busch JM, Megann EF. An early abdominal wall ectopic pregnancy successfully treated with ultrasound guided intralesional methotrexate: a care report. Obstet Gynecol Intern. 2009;2009:247252.Google Scholar
  27. 27.
    Chui AK, Lo KW, Choi PC, Sung MC, Lau JW. Primary hepatic pregnancy. Aust N Z J Surg. 2001;71:260–1.CrossRefGoogle Scholar
  28. 28.
    Nama V, Gyampoh B, Karoski M, McRea R, Opemuyi I. Secondary abdominal appendicular ectopic pregnancy. J Minim Invasive Gynecol. 2007;14:516–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Shippey SH, Bhoola SM, Royek AB, Long ME. Diagnosis and management of hepatic ectopic pregnancy. Obstet Gynecol. 2007;109:544–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Thompson RJ, Hawe MJ. A rare pathological trinity: an appendiceal ectopic pregnancy, acute appendicitis, and a carcinoid tumor. Ir J Med Sci. 2011;180(2):579–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Yagil Y, Beck-Razi N, Amit A, Kerner H, Gaitini D. Splenic pregnancy: the role of abdominal imaging. J Ultrasound Med. 2007;26:1629–32.PubMedGoogle Scholar
  32. 32.
    Martin JN, Sessums JK, Martin RW, Proyer JA, Morrison JC. Abdominal pregnancy: current concepts of management. Obstet Gynecol. 1988;71:549–62.PubMedGoogle Scholar
  33. 33.
    Fait G, Goyert G, Sundareson A, Pickens Jr A. Intramural pregnancy with fetal survival: case history and discussion of etiologic factors. Obstet Gynecol. 1987;70:472–4.PubMedGoogle Scholar
  34. 34.
    McGowan L. Intramural pregnancy. JAMA. 1965;192:637–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. 1997;177:210–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Huang KH, Lee CL, Wang CJ, Soong YK, Lee KF. Pregnancy in a previous cesarean section scar: case report. Changgeng Yi Xue Za Zhi. 1998;21:323–7.PubMedGoogle Scholar
  37. 37.
    Marcus S, Cheng E, Goff B. Extrauterine pregnancy resulting from early uterine rupture. Obstet Gynecol. 1999;94:804–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous cesarean section scar. Fertil Steril. 1997;67:398–400.PubMedCrossRefGoogle Scholar
  39. 39.
    Tulandi T, Al-Jaroudi D. Interstitial pregnancy: results generated from the 92. Society of Reproductive Surgeons Registry. Obstet Gynecol. 2004;103:47–50.PubMedCrossRefGoogle Scholar
  40. 40.
    Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril. 1999;72:207–15.PubMedCrossRefGoogle Scholar
  41. 41.
    Moawad NS, Mahajan ST, Moniz MH, Taylor SE, Hurd WW. Current diagnosis and treatment of interstitial pregnancy. Am J Obstet Gynecol. 2010;202:15–29.PubMedCrossRefGoogle Scholar
  42. 42.
    Ackerman TE, Levi CS, Dashefsky SM, Holt SC, Lindsay DJ. Interstitial line: sonographic finding in interstitial (cornual) ectopic pregnancy. Radiology. 1993;189:83–7.PubMedGoogle Scholar
  43. 43.
    Timor-Tritsch IE, Monteagudo A, Matera C, Veit CR. Sonographic evolution of cornual pregnancy treated without surgery. Obstet Gynecol. 1992;79:1044–9.PubMedGoogle Scholar
  44. 44.
    Rastogi R, Meena GL, Rastogi N, Rastogi V. A rare and difficult clinicosonographic diagnosis. J Hum Reprod Sci. 2008;1:81–2.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Fylstra DL. Ectopic pregnancy after hysterectomy: a review and insight into etiology and prevention. Fertil Steril. 2010;94:431–5.PubMedCrossRefGoogle Scholar
  46. 46.
    American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 94. Medical management of ectopic pregnancy. Obstet Gynecol. 2009;111:1479–85.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of OBGYNMedical University of South CarolinaCharlestonUSA

Personalised recommendations