TRANSVAGINAL DOPPLER SONOGRAPHY FOR DETECTING ECTOPIC PREGNANCY - IS IT REALLY NECESSARY

In this prospective study we compared transvaginal duplex Doppler ultr asound with two-dimensional imaging for the diagnosis or exclusion of ectopic pregnancies. The study group comprised 76 stable patients with serum beta-human chorionic gonadotropin (hCG) levels > 100 mIU/ml in whom ectopic pregnancy was clinically suspected. Ectopic pregnancies w ere verified in 42 patients (60%), intrauterine pregnancies (normal an d abnormal) in 19 (27%), and possible complete abortions, either intau terine or extrauterine, in 9 patients (13%). Based on 2-D imaging alon e, the appearance of an adnexal mass separated from the ovaries, and a lack of clear intrauterine gestational sac indicated ectopic pregnanc y with a sensitivity of 95%. Intrauterine sac-like structures and abse nce of adnexal masses excluded ectopic pregnancies with a specificity of 89%. High velocity systolic flow, and low impedance diastolic flow which characterizes trophoblastic tissue when detected outside the ute rus, had a sensitivity of 48%, while the presence of trophoblastic sig nals in the uterus or their absence outside the uterus excluded ectopi c pregnancies with a specificity of 89%. The positive predictive value s were 91% for Doppler and 95% for 2-D imaging, while the negative pre dictive values were 89% for imaging alone and 44% for Doppler. These d ata suggest that transvaginal Doppler ultrasound has significant lower sensitivity and negative predictive value and does not provide more u seful diagnostic information than 2-D imaging alone for stable patient s with suspected ectopic pregnancies.