Applid new sonographic scoring system for early diagnosis of ectopic pregnancy

Abstract EN

Objective: To apply a simplified ultrasound scoring system help in early and proper diagnosis of ectopic pregnancy in suspected cases.

Patients and Methods: From January 2005 to May 2008, 300 clinically suspected cases of ectopic pregnancy with positive pregnancy test were scanned by both trans-abdominal and trans-vaginal ultrasound.

A systemic approach of scanning technique was applied for every case (scan the uterus at first, then the adnexa and cul-de-sac, and finally look for other areas of peritoneal cavity for free fluid).

Doppler study with color flow mapping was done to help in differential diagnosis of confusing pictures of adnexal masses.

Sonographer findings were recorded in a designed simple scoring system composed of (0, 1, 2) which mean that: 0 = monographic picture not commonly seen in ectopic pregnancy. 1 = monographic picture confused with ectopic pregnancy. 2 = Typical monographic picture seen in ectopic pregnancy.

Quantitative B-hCG level was done to confirm the diagnosis. Results' 258 cases diagnosed to be ectopic pregnancy by this designed ultrasound scoring system and proved by data of B-hCG and laparoscopic and/or laparotomy findings.

The cut-off point of this new scoring system >3 had the strongest correlation with presence of ectopic pregnancy (P-value = < 0.0001).

34 cases were potentially diagnosed as of non-ectopic pregnancy by using this scoring system and after that the diagnosis was found correct.

The other 8 patients with confusing results presented with abdominal pain, adnexal mass and missed period and positive pregnancy test confirmed later and suspected to be ectopic pregnancy by high score on ultrasound scanning and on Laparoscopy, 5 of them found non ectopic (Early Intrauterine pregnancy) and the other 3 confirmed that early tubal.