P05.06: Sonography features of ectopic pregnancy: three years experience in a London University Hospital

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To study the various ultrasound features of ectopic pregnancy in relation to management option. A three year prospective cohort study of sonomorphologic features of ectopic pregnancy was conducted from January 2009 to December 2011. All women with suspected ectopics were enrolled consecutively into the study, evaluated with ultrasonography, and management was based on patient's symptoms. Ultrasonographic features of extrauterine pregnancy were classified into five categories; 1) Gestational sac alone (bagel sign), 2) GS with an embryo but no heart rate, 3) GS with a yolk sac, 4) Inhomogeneous mass (blob sign), and 5) Gestational sac (GS) with a live embryo (live). A total of 240 cases of ectopic pregnancies were diagnosed. Transvaginal (TVS) and Transabdominal scans (TAS) were performed in 92% and 8% women respectively. Pelvic free fluid was associated with 82% of ectopic pregnancies. TVS features of extrauterine EP were identified in 91% of women with adnexa mass. These include 25% with a gestational sac alone (Bagel), with yolk sac or/and embryo; inhomogeneous mass in 55%; 13% had live embryo, and in 7% the index pregnancy was not visualised in symptomatic patients. TAS was performed in 8% unstable patients and inhomogeneous mass was visualised in 12 women. Laparoscopy confirmed diagnosis in 97%, management was successful in 96%, and 3 cases were converted to laparotomy. Four cases of failed medical management had embryonic features on repeated ultrasonography needed laparoscopy treatment. Presence of embryonic material in a diagnosed ectopic pregnancy is a potential risk for failed medical management as shown in these cases. At least one sonographic feature, commonly inhomogeneous mass and presence of echogenic free fluid in POD were the commonest ultrasound findings in the diagnosis of ectopic pregnancy. All patients in our series were correctly selected for laparoscopic management without serous morbidity.

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