The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Sonographic Assessment of Endometrial Thickness and Endometrial Patterns in Ectopic Pregnancy: A New Perspective

Document Type : Original Article

Authors
Roghieh Molaei-Langroudi 1
Ehsan Kazemnejad-Leili 2
1 Assistant professor, Department of Radiology and Sonography, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
2 Associate professor, Department of Vital Statistics, Road Trauma Research Center, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
10.22038/ijogi.2019.13997
Abstract
Introduction: Ectopic pregnancy occurs during the first three months of pregnancy which leads to extensive mortality and disability. Early diagnosis and treatment of this type of pregnancy may be helpful in prevention and reducing its complications. This study was performed with aim to evaluate the endometrial thickness and sonographic endometrial patterns in ectopic pregnancy.
Methods: This case-control study was conducted on 179 patients (91 women with normal increase of serial βHCG and diagnosis of normal pregnancy and 88 with abnormal increase of serial βHCG and diagnosis of ectopic pregnancy) with positive pregnancy result and vaginal bleeding with or without abdominal pain at first trimester of pregnancy in Al-Zahra educational hospital, Rasht from March 20, 2016 to September 22, 2017. Patients underwent vaginal sonography by a gynecologist to rule out the ectopic pregnancy. Endometrial thickness and patterns were evaluated. Data were analyzed by SPSS software (version 17), and student t-test, and Chi-squared test. P < 0.05 was considered statistically significant.
Results: In normal and ectopic pregnancy groups, endometrial pattern was homogeneous hyperechoic, heterogeneous hyperechoic and three-layered. Based on the results of student t-test, no significant difference was observed between endometrial ultrasound patterns in two groups (p>0.05). Mean endometrial thickness in normal pregnancy and ectopic pregnancy groups were 14.8±3.1 mm and 8.2±4.9 mm, respectively which was significantly higher in normal pregnancy group than ectopic pregnancy group (p<0.0001).
Conclusion: Use of endometrial thickness may be helpful as a diagnostic tool in ectopic pregnancy. Use of sonographic endometrial pattern has a low diagnostic value in distinguishing ectopic pregnancy from normal pregnancy.
Keywords
Ectopic pregnancy
Endometrial pattern
Endometrial thickness
Sonography
  1. Yadav P, Singla A, Sidana A, Suneja A, Vaid NB. Evaluation of sonographic endometrial patterns and endometrial thickness as predictors of ectopic pregnancy. Int J Gynecol Obstet 2017; 136(1):70-5.
  2. Guerriero S, Martins WP, Alcazar JL. Managing ultrasonography in human reproduction: a practical handbook. Switzerland: Springer; 2016. P. 214-34.
  3. Taran FA, Kagan KO, Hübner M, Hoopmann M, Wallwiener D, Brucker S. The diagnosis and treatment of ectopic pregnancy. Deutsches Arzteblatt Int 2015; 112(41):693-703.
  4. Nankali A, Shirzadi N, Rezaei M, Daeichin S. Trends in the treatment and clinical presentations of tubal ectopic pregnancy in Imam Reza Hospital of Kermanshah, Iran (2007-2011). Iran J Obstet Gynecol Infertil 2014; 17(95):1-7. (Persian).
  5. Richardson A, Gallos I, Dobson S, Campbell BK, Coomarasamy A, Raine-Fenning N. Accuracy of first-trimester ultrasound in diagnosis of tubal ectopic pregnancy in the absence of an obvious extra uterine embryo: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2016; 47(1):28-37.
  6. Santos-Ribeiro S, Tournaye H, Polyzos NP. Trends in ectopic pregnancy rates following assisted reproductive technologies in the UK: a 12-year nationwide analysis including 160 000 pregnancies. Hum Reprod 2016; 31(2):393-402.
  7. Gurel S, Sarikaya B, Gurel K, Akata D. Role of sonography in the diagnosis of ectopic pregnancy. J Clin Ultrasound 2007; 35(9):509-17. 
  8. Yasin S, Sciaky-Tamir Y, Mostafa E, Ohel-Shani I, Daniel-Spiegel E. Endometrial-pattern in early pregnancy and correlation with ectopic-pregnancy. Harefuah 2018; 157(9):599-603.
  9. Hammoud AO, Hammoud I, Bujold E, Gonik B, Diamond MP, Johnson SC. The role of sonographic endometrial patterns and endometrial thickness in the differential diagnosis of ectopic pregnancy. Am J Obstet Gynecol 2005; 192(5):1370-5.
  10. Hajshafiha M, Salarilac SH, Rafie S, Kiarang N, Ketabati F. Investigation the association between age, cause of infertility, and number of embryo transferred with ectopic pregnancy and multiple pregnancy in infertile couples under intra cytoplasmic sperm injection (ICSI) treatment. J Guilan Univ Med Sci 2011; 20(78):8-15. (Persian).
  11. Wachsberg RH, Karimi S. Sonographic endometrial three-layer pattern in symptomatic first-trimester pregnancy: not diagnostic of ectopic pregnancy. J Clin Ultrasound 1998; 26(4):199-201.
  12. Lavie O, Boldes R, Neuman M, Rabinovitz R, Algur N, Beller U. Ultrasonographic “endometrial three‐layer” pattern: a unique finding in ectopic pregnancy. J Clin Ultrasound 1996; 24(4):179-83.
  13. Yang Y, Liu Z, Song L, Liu H, Li L, Meng Y. Diagnosis and surgical therapy of the retroperitoneal ectopic pregnancy: a case report. Int J Surg Case Rep 2018; 49:21-4.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 22, Issue 9
November 2019
Pages 8-14