Finding-the-Path: Pelvic ultrasound

Endovaginal ultrasonography

Endovaginal ultrasound shows no intrauterine pregnancy. There is a gestational sac adjacent to the left ovary (LO) containing a yolk sac (arrow), fetal pole (arrow) and fetal heart (arrow). The fetal heart rate is 139 bpm. A small amount of free fluid is visible in the cul-de-sac (arrow). These findings are diagnostic of a left ectopic pregnancy.

Discussion

Ectopic pregnancy occurs in 1:100-400 pregnancies and accounts for 15% of maternal deaths. The only sonographic finding that reliably excludes an ectopic pregnancy is a demonstration of an intrauterine pregnancy since concomitant presence of an intrauterine and an extrauterine pregnancy is extremely rare (except in induced ovulation). Endovaginal ultrasound can detect a living embryo in 30% of ectopic pregnancies. Presence of an adnexal mass and/or cul-de-sac fluid in a patient with no intrauterine gestation and measurable circulating human chorionic gonadotropin (HCG) are highly specific for the diagnosis of ectopic pregnancy. However, absence of these findings does not exclude the diagnosis since up to 30% of women with extrauterine gestations have no sonographic evidence of an adnexal mass or pelvic intraperitoneal fluid. A pseudogestational sac (decidual reaction and anechoic fluid collection in the endometrial cavity) can be seen in 10-20% of ectopic pregnancies and should not be confused with an intrauterine gestation. Ninety-five percent of ectopic pregnancies occur in the fallopian tubes. Ovarian, abdominal, cervical and interligamentary ectopics are rare.

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