DOES TRANSVAGINAL COLOR DOPPLER SONOGRAPHY DIFFERENTIATE BETWEEN DEVELOPING AND INVOLUTING ECTOPIC PREGNANCIES

The objective of this study was to assess the addition of transvaginal color Doppler imaging to transvaginal ultrasonography and beta-human chorionic gonadotropin values to differentiate between developing and involuting ectopic pregnancies. Forty surgically confirmed ectopic pre gnancies were classified into developing or involuting according to hi stopathologic findings. Results were compared retrospectively with the plasma beta-human chorionic gonadotropin values as well as the resist ive index and pulsatility index obtained in corpora lutea and peritrop hoblastic flow in serial examinations. Student's t-test was used for c omparison of means. Logistic regression analysis was applied to predic t the binary dependent variable in women with a developing or involuti ng ectopic pregnancy by analyzing a set of independent variables, seru m beta-human chorionic gonadotropin levels, and resistive and pulsatil ity indices of corpora lutea and adnexal masses. Twenty-seven ectopic pregnancies were developing and 13 were involuting. The women with dev eloping ectopic pregnancies had significantly higher serum levels of b eta-human chorionic gonodotropin than those with involuting ectopic pr egnancies (P < 0.05). Furthermore, women with developing ectopic pregn ancies showed a 15 to 20% decrease in the resistive index and pulsatil ity index baseline every four days. In contrast, we were unable to dis tinguish between developing and involuting ectopic pregnancies by anal yzing beta-human chorionic gonadotropin values at this early stage of gestation. The logistic regression model showed that a corpus luteum r esistive index increase was the only marker that predicted involution of an ectopic pregnancy before day 49. Similarly, after day 49 an incr ease in tubal mass resistive index was the only parameter that consist ently identifies an involuting tubal ectopic pregnancy. Our observatio ns demonstrate that adnexal flow mapping with transvaginal color Doppl er sonography can detect developing and involuting tubal ectopic pregn ancies. Until the 49th day, an increase in corpus luteum resistive and pulsatility indices identifies an involuting ectopic pregnancy. After the 49th day, an increase in tubal mass resistive and pulsatility ind ices identifies an involuting ectopic pregnancy.