Diagnostic Value of Transvaginal Ultrasonography in the Evaluation of Ectopic Pregnancy with β-hCG Levels Lower than 1000 mIU/ml

Document Type : Original Article

Authors

1 General Practitioner, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.

2 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.

3 M.Sc. in Medical Library and Information Sciences, Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran.

10.22038/ijogi.2024.82916.6218

Abstract

Introduction: Considering the importance of early diagnosis of ectopic pregnancy to prevent its complications and mortality, the present study was conducted with aim to determine the diagnostic value of transvaginal ultrasonography in the evaluation of ectopic pregnancy with β-hCG levels lower than 1000 mIU/ml.
Methods: This prospective study was conducted in 2020-2021 to determine the diagnostic value of transvaginal sonography in the evaluation of ectopic pregnancy in women referred to the clinic or department of gynecology in Afzalipour Hospital, Kerman. The inclusion criteria were the presence of one or more of the triad symptoms of ectopic pregnancy, i.e. abdominal or pelvic pain, amenorrhea and unusual vaginal bleeding, and serum β-hCG level less than 1000 mIU/mL. If no intrauterine gestational sac was seen and a mass indicative of ectopic pregnancy was found, or if no intrauterine gestational sac was seen without other findings outside the uterus, patients were followed up by measuring serum β-hCG levels every 48 hours until a definitive diagnosis was made. Data analysis was done using SPSS statistical software (version 22). P<0.05 was considered significant.
Results: The mean gestational age in individuals with a correct diagnosis of ectopic pregnancy was 5.91±1.48 weeks. The sensitivity and specificity of transvaginal ultrasound were 50% and 66%, respectively. Positive and negative predictive values were measured as 78.26% and 35.71%, respectively.
Conclusion: In the present study, the sensitivity and specificity of transvaginal ultrasound in diagnosing ectopic pregnancy at β-hCG levels less than 1000 mIU/ml were reported as 50% and 66%, respectively. As a result, efforts to find a more accurate diagnostic method for early diagnosis of ectopic pregnancy are still needed.

Keywords

Main Subjects


  1. Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. Fertility research and practice 2015; 1:1-20.
  2. Brady PC, Ginsburg ES. An updated review of ectopic pregnancies resulting from assisted reproduction. Current Obstetrics and Gynecology Reports 2017; 6:21-5.
  3. Kirk E, Condous G, Bourne T. Pregnancies of unknown location. Best Practice & Research Clinical Obstetrics & Gynaecology 2009; 23(4):493-9.
  4. Silva C, Sammel MD, Zhou L, Gracia C, Hummel AC, Barnhart K. Human chorionic gonadotropin profile for women with ectopic pregnancy. Obstetrics & Gynecology 2006; 107(3):605-10.
  5. Dashe J, Bloom S, Spong C, Hoffman B. Williams Obstetrics. 25nd McGraw Hill LLC; 2018.
  6. Mehta TS, Levine D, Beckwith B. Treatment of ectopic pregnancy: is a human chorionic gonadotropin level of 2,000 mIU/mL a reasonable threshold?. Radiology 1997; 205(2):569-73.
  7. Mullany K, Minneci M, Monjazeb R, C. Coiado O. Overview of ectopic pregnancy diagnosis, management, and innovation. Women's Health 2023; 19:17455057231160349.
  8. Hasani M, Keramat A, Khosravi A, Oshrieh Z, Hasani M. Prevalence of ectopic pregnancy in Iran: A systematic review and meta-analysis. The Iranian Journal of Obstetrics, Gynecology and Infertility 2016; 19(23):15-23.
  9. Lu Q, Wang Y, Sun X, Li Y, Wang J, Zhou Y, et al. The diagnostic role of the β-hCG discriminatory zone combined with the endometrial pattern for ectopic pregnancy in Chinese women. Scientific reports 2019; 9(1):13781.
  10. Baker M, dela Cruz J. Ectopic Pregnancy, Ultrasound. 2023 Jan 16. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29489174.
  11. Cacciatore B, Stenman UH, Ylöstalo P. Diagnosis of ectopic pregnancy by vaginal ultrasonography in combination with a discriminatory serum hCG level of 1000 IU/1 (IRP). BJOG: An International Journal of Obstetrics & Gynaecology 1990; 97(10):904-8.
  12. Kadar N, Bohrer M, Kemmann E, Shelden R. The discriminatory human chorionic gonadotropin zone for endovaginal sonography: a prospective, randomized study. Fertility and sterility 1994; 61(6):1016-20.
  13. Kohn MA, Kerr K, Malkevich D, O'Neil N, Kerr MJ, Kaplan BC. Beta‐Human Chorionic Gonadotropin Levels and the Likelihood of Ectopic Pregnancy in Emergency Department Patients with Abdominal Pain or Vaginal Bleeding. Academic emergency medicine 2003; 10(2):119-26.
  14. Soussis I, Dimitry ES, Oskarsson T, Margara R, Winston R. Diagnosis of ectopic pregnancy by vaginal ultrasonography in combination with a discriminatory serum hCG level of 1000 IU/1 (IRP). BJOG: An International Journal of Obstetrics & Gynaecology 1991; 98(2):233-.
  15. Nyberg DA, Mack LA, Laing FC, Jeffrey RB. Early pregnancy complications: endovaginal sonographic findings correlated with human chorionic gonadotropin levels. Radiology 1988; 167(3):619-22.
  16. Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. Cmaj 2005; 173(8):905-12.
  17. Igwegbe AO, Eleje GU, Okpala BC. An appraisal of the management of ectopic pregnancy in a Nigerian tertiary hospital. Annals of medical and health sciences research 2013; 3(2):166-70.
  18. 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). The Iranian Journal of Obstetrics, Gynecology and Infertility 2014; 17(95):1-7.
  19. Ayaz A, Emam S, Farooq MU. Clinical course of ectopic pregnancy: A single-center experience. Journal of human reproductive sciences 2013; 6(1):70-3.
  20. Ghatreh Samani F, Nourian A, Farzadi L. Transvaginal Ultrasound Compared with Serum β-hCG Level for Diagnosis of Ectopic Pregnancy in Symptomatic Patients. J Arak Uni Med Sci 2018; 20(10):90-100.
  21. Kirk E, Papageorghiou AT, Condous G, Tan L, Bora S, Bourne T. The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy. Human reproduction 2007; 22(11):2824-8.
  22. Condous G, Okaro E, Khalid A, Lu C, Van Huffel S, Timmerman D, et al. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Human reproduction 2005; 20(5):1404-9.
  23. Dart RG, Kaplan B, Cox C. Transvaginal ultrasound in patients with low β-human chorionic gonadotropin values: How often is the study diagnostic?. Annals of emergency medicine 1997; 30(2):135-40.
  24. Gabrielli S, Romero R, Pilu G, Pavani A, Capelli M, Milano V, et al. Accuracy of transvaginal ultrasound and serum hCG in the diagnosis of ectopic pregnancy. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 1992; 2(2):110-5.
  25. Polanski L, McKay R, Ayling E, Baumgarten M. OP11. 04: Should the beta hCG threshold level for ultrasound in the diagnosis of tubal ectopic pregnancies be abolished?. Ultrasound in Obstetrics & Gynecology 2017; 50:81.
  26. Zeynizadeh Jeddi S, Mobaraki N, Pirzadeh A. Transvaginal ultrasound compared with serum β-hCG level for diagnosis of ectopic pregnancy in symptomatic patients. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2020; 9(3):1228-33.