DOPPLER SONOGRAPHY CRITERIA FOR THE VIABI LITY OF CLINICALLY STABLE ECTOPIC PREGNANCIES - AN AID FOR DECIDING ON THE THERAPEUTIC PROCEDURE

The differentiation between viable ectopic pregnancies with trophoblas tic activity and tubal abortions could be a therapeutic aid for the de termination of an operative versus a conservative management. Since th e typical sonographic picture of an ectopic pregnancy - an extrauterin e gestational sac surrounded by an echogenic ring - corresponds histol ogically to the oedematous tube in combination with the trophoblast, g ood vascularisation within this structure should indicate the chorioni c activity of the ectopic pregnancy and thereby its viability. In 34 p atients with sonographically definitely confirmed ectopic pregnancy fr om the 6(th) to 10(th) week of gestation who presented with typical bu t not acute symptoms of an EP (bleeding disorders, positive pregnancy test together with an empty uterus in sonography, slight ache in the l ower abdomen or sonographic proof of an ectopic pregnancy in private p ractice) we therefore examined this echogenic ring by transvaginal col our Doppler sonography (Acuson 128 XP/10, 5 Mhz transvaginal probe EV 519) in a prospective study. Subsequently 29 patients underwent laparo scopy or laparotomy where 16 tubes had to be removed partially or comp letely. The histological examination of the removed tissue was perform ed by haematoxyline-eosine staining as well as by immune histochemical methods (factor VIII-antibody, Dako, Heidelberg, FRG) to identify and precisely localise the vessels in the area of the ectopic pregnancy s een in the Doppler sonographic examination. In accordance with the inc reasing experience with this technique, five patients were treated by conservative methods (single i.v. administration of methotrexate, 30 m g). Whereas viable ectopic pregnancies (n=11) exhibited a ring of vess el spots at the rim of this echogenic ring, there were only three or l ess weak vessel spots or even no Vessel spots at all in tubal abortion (n=23). The Doppler sonographic findings could also be verified on hi stological examination; this correlation was statistically significant also after subtracting the five ectopic pregnancies with positive hea rt beat (p<0.01; Fisher's exact test). The major therapeutic problem e specially of the conservative approach was the slow normalisation of t he pregnancy hormone. Even if this is taken into account, Doppler sono graphy of the echogenic ring around the extrauterine gestational sac i s nevertheless an additional help for counselling the clinically stabl e patient concerning further therapeutic procedures, since it is a fas t and simple method for determining the viability of an ectopic pregna ncy. It provides a certain independence of the laboratory concerning t he determination of the pregnancy hormone and it correlates with the e nsuing histological examination.