SONOGRAPHIC ENDOMETRIAL 3-LAYER PATTERN IN SYMPTOMATIC FIRST-TRIMESTER PREGNANCY - NOT DIAGNOSTIC OF ECTOPIC PREGNANCY

Purpose. We evaluated a recent report that suggested that a ''3-layer' ' appearance of the endometrium on sonography is diagnostic of ectopic pregnancy in symptomatic pregnant patients. Methods. We reviewed the log of pelvic sonograms performed to rule out ectopic pregnancy in wom en presenting with first-trimester bleeding and/or pain during a 29-mo nth period. Medical records and sonograms of patients without sonograp hic evidence of intrauterine pregnancy were reviewed to determine fina l diagnoses and whether the 3-layer pattern was present. Results. One hundred twenty patients with available follow-up had no sonographic ev idence of intrauterine pregnancy. Fifty-nine (49%) had ectopic pregnan cy. An endometrial 3-layer pattern was noted sonographically in 15 pat ients (13%), of whom 6 (40%) had ectopic pregnancy. As a diagnostic si gn of ectopic pregnancy, the endometrial 3-layer pattern had a sensiti vity of 10.2%, specificity of 85.2%, positive predictive value of 40%, negative predictive value of 50.5%, and accuracy of 49.2%. Conclusion s. The endometrial 3-layer pattern is neither sensitive nor specific f or the diagnosis of ectopic pregnancy. (C) 1998 John Wiley & Sons, Inc .