DIAGNOSTIC ACCURACY OF TRANSVAGINAL ULTRASOUND IN EARLY (FIRST TRIMESTER) DETECTION OF ECTOPIC PREGNANCY AND TO EXCLUDE AN ALTERNATIVE DIAGNOSIS.

Abstract

BACKGROUND: Ectopic pregnancy is a high risk condition that occurs in 1.9% of reported pregnancies. In the United States, ectopic pregnancy is estimated to occur in 1-2% of all pregnancies and accounts for 3-4% of all pregnancy related deaths. In Pakistan, the reported incidence has been cited as 1:112 to 1:130.This study is a cross sectional prospective study of 469 patients clinically suspected for ectopic pregnancy. OBJECTIVE: The objective of this study was to determine Diagnostic accuracy of Transvaginal ultrasound in early (first trimester) detection of ectopic pregnancy and to exclude an alternative diagnosis. MATERIALS & METHODS: A total of 469 patients of reproductive age group (14-45yrs) presenting with complains of amenorrhea with or without vaginal bleeding, lower abdominal pain and Serum Beta (hCG) to a range of 192-10,500mIU/ml were included in the study. These patients underwent transvaginal ultrasonography followed by surgery. Histopathological correlation was also done. RESULTS: The results proved that Transvaginal ultrasound had a sensitivity of 93.98%, specificity of 95.07%, accuracyof 94.45%, PPV of 96.15% and NPV of 92.34% for the diagnosis of ectopic pregnancy. Most patients were between 25-35 yrs of age 53.30% and presented between 7-9 months of amenorrhea. Most common primary feature on ultrasound was complex adnexal mass 43.4% and fluid in pouch of douglas was the secondary sign 80%. Multiple alternative diagnosis were also made like missed abortion, haemorhagic/ complex/ endometriotic cyst, ovarian torsion, tubo-ovarian abscess, PID and uterine fibroid. Of these missed abortion was the most commonest 51.8%. CONCLUSION: Transvaginal ultrasonography performed in patients with suspected ectopic pregnancy improves patient care by early detection of ectopic pregnancy that will decrease the morbidity and mortality associated with it.