ROLE OF ENDOVAGINAL SONOGRAPHY IN THE DIAGNOSIS AND MANAGEMENT OF ECTOPIC PREGNANCY

Although diagnostic laparoscopy is still considered the standard refer ence in the diagnosis of ectopic pregnancy (EP), use of high-resolutio n endovaginal sonography, in conjunction with qualitative serum assays of the beta subunit of human chorionic gonadotropin (beta-hCG), allow s detection of earlier and smaller EPs. The most common endovaginal so nographic finding of EP (89%-100% of cases) is an extraovarian, round or elongated, solid tubal mass. A tubal ring (an extrauterine saclike structure) is the second most common finding (40%-68% of cases). Pelvi c fluid may be present, but it is a nonspecific finding. An EP may hav e a pseudosac, which can be distinguished sonographically from the tru e gestational sac of an intrauterine pregnancy. Color Doppler techniqu es can complement endovaginal sonographic findings, but they should be performed only after a thorough real-time evaluation of the adnexal r egion. Current therapeutic options for EP include expectant management (ie, close follow-up), medical treatment (usually injections of metho trexate), and surgery. Accurate diagnosis with endovaginal sonography is the prerequisite to nonsurgical management, since surgery is the lo gical treatment if laparoscopy is used for diagnosis.