Diagnostic index of doppler sonography in ectopic pregnancy

Elham Shobairi, Nasrin Jalilian, Mansour Rezaie, Sara Behafarid


Background: As delay in diagnosis of ectopic pregnancy is directly associated with increasing mortality, it studying the high sensitivity and specificity of transvaginal color doppler sonography as the most preferred imaging method with the most accurate and rapid diagnosis results seems to be necessary. Therefore, this study aims to evaluate the diagnostic value of transvaginal color doppler sonography in ectopic pregnancies.

Methods: In this cross-sectional study, patients with suspected ectopic pregnancy who had undergone surgery were enrolled in the study. Patients were evaluated by transvaginal color doppler sonography diagnosis; surgery was considered as the gold standard for diagnosis. Diagnostic test indicators were calculated and the ROC curve was plotted for quantitative indicators.

Results: The diagnosis of ectopic pregnancy doppler sonography had sensitivity, specificity, and positive and negative predictive values equal to 97.1%, 94.3%, 94.4% and 97%, respectively. For ovarian mass cases the sensitivity was 100% but it was 85.7% in false positive cases. The sensitivity and specificity of Leash sign were calculated as 28.6% and 100% respectively. The difference between two RI values ​​higher than 0.095 was in favor of ectopic pregnancy; in that point the sensitivity and specificity were 60% and 82.8% respectively.

Conclusion: Transvaginal doppler sonography has high diagnostic value in diagnosis of ec-pic pregnancy. Using adnexal mass, which has a high sensitivity, and then studying a positive Leach sign, which has a high specificity, could be a very efficient diagnosis composition.


Barnhart KT. Ec-pic Pregnancy. New England Journal of Medicine. 2009;361(4):379-87.

Della-Giustina D, Denny M. Ec-pic pregnancy. Emerg Med Clin North Am. 2003;21(3):565-84.

Chang J, Elam-Evans L, Berg C, Herndon J, Flowers L, Seed K, et al. Pregnancy-related mortality surveillance-United States, 1991-1999. Surveill Summ. 2003;52((SS02)):1-8.

Nederlof KP, Lawson HW, Saftlas AF, Atrash HK, Finch EL. Ec-pic pregnancy surveillance, United States, 1970-1987. MMWR CDC Surveill Summ. 1990;39(4):9-17.

Tay JI, Moore J, Walker JJ. Ec-pic pregnancy. BMJ. 2000;320(7239):916-9.

Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk fac-rs for ec-pic pregnancy: a meta-analysis. Fertil Steril. 1996;65(6):1093-9.

Tenore JL. Ec-pic pregnancy. Am Fam Physician. 2000;61(4):1080-8.

Atri M, Chow CM, Kintzen G, Gillett P, Aldis AA, Thibodeau M, et al. Expectant treatment of ec-pic pregnancies: clinical and sonographic predic-rs. AJR Am J Roentgenol. 2001;176(1):123-7.

Lozeau AM, Potter B. Diagnosis and management of ec-pic pregnancy. Am Fam Physician. 2005;72(9):1707-14.

Guvendag Guven ES, Dilbaz S, Dilbaz B, Guven S, Sahin Ozdemir D, Haberal A. Serum biochemistry correlates with the size of tubal ec-pic pregnancy on sonography. Ultrasound Obstet Gynecol. 2006;28(6):826-30.

Condous G, Kirk E, Lu C, Van Huffel S, Gevaert O, De Moor B, et al. Diagnostic accuracy of varying discrimina-ry zones for the prediction of ec-pic pregnancy in women with a pregnancy of unknown location. Ultrasound Obstet Gynecol. 2005;26(7):770-5.

Thorsen MK, Lawson TL, Aiman EJ, Miller DP, McAsey ME, Erickson SJ, et al. Diagnosis of ec-pic pregnancy: endovaginal vs transabdominal sonography. AJR Am J Roentgenol. 1990;155(2):307-10.

Barnhart K, Mennuti MT, Benjamin I, Jacobson S, Goodman D, Coutifaris C. Prompt diagnosis of ec-pic pregnancy in an emergency department setting. Obstet Gynecol. 1994;84(6):1010-5.

Shalev E, Yarom I, Bustan M, Weiner E, Ben-Shlomo I. Transvaginal sonography as the ultimate diagnostic -ol for the management of ec-pic pregnancy: experience with 840 cases. Fertil Steril. 1998;69(1):62-5.

Orden MR, Gudmundsson S, Helin HL, Kirkinen P. Intravascular contrast agent in the ultrasonography of ec-pic pregnancy. Ultrasound Obstet Gynecol. 1999;14(5):348-52.

Pelleri- JS, Taylor KJ, Quedens-Case C, Hammers LW, Scoutt LM, Ramos IM, et al. Ec-pic pregnancy: evaluation with endovaginal color flow imaging. Radiology. 1992;183(2):407-11.

Kurjak A, Zalud I, Schulman H. Ec-pic pregnancy: transvaginal color Doppler of trophoblastic flow in questionable adnexa. J Ultrasound Med. 1991;10(12):685-9.

Achiron R, Goldenberg M, Lipitz S, Mashiach S, Oelsner G. Transvaginal Doppler sonography for detecting ec-pic pregnancy: is it really necessary. Isr J Med Sci. 1994;30(11):820-5.

Kirchler HC, Kolle D, Schwegel P. Changes in tubal blood flow in evaluating ec-pic pregnancy. Ultrasound Obstet Gynecol. 1992;2(4):283-8.

Caccia-re B, Stenman UH, Ylostalo P. Comparison of abdominal and vaginal sonography in suspected ec-pic pregnancy. Obstet Gynecol. 1989;73(5 Pt 1):770-4.

Mol BW, Hajenius PJ, Engelsbel S, Ankum WM, Van der Veen F, Hemrika DJ, et al. Serum human chorionic gonadotropin measurement in the diagnosis of ec-pic pregnancy when transvaginal sonography is inconclusive. Fertil Steril. 1998;70(5):972-81.

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 ec-pic pregnancy. Ultrasound Obstet Gynecol. 1992;2(2):110-5.

Caccia-re B, Stenman UH, Ylostalo P. Diagnosis of ec-pic pregnancy by vaginal ultrasonography in combination with a discrimina-ry serum hCG level of 1000 IU/l (IRP). Br J Obstet Gynaecol. 1990;97(10):904-8.

Kaplan BC, Dart RG, Moskos M, Kuligowska E, Chun B, Adel Hamid M, et al. Ec-pic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med. 1996;28(1):10-7.

Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ec-pic pregnancy. CMAJ. 2005;173(8):905-12.

Condous G, Oaro E, Bourne T. The management of ec-pic pregnancies and pregnancies of unknown location. Gynecol Surg. 2004;1:81-6.

Emerson DS, Cartier MS, Altieri LA, Felker RE, Smith WC, S-vall TG, et al. Diagnostic efficacy of endovaginal color Doppler flow imaging in an ec-pic pregnancy screening program. Radiology. 1992;183(2):413-20.

Condous G, Okaro E, Khalid A, Lu C, Van Huffel S, Timmerman D, et al. The accuracy of transvaginal ultrasonography for the diagnosis of ec-pic pregnancy prior - surgery. Hum Reprod. 2005;20(5):1404-9.

Chew S, Anandakumar C, Vanaja K, Wong YC, Chia D, Ratnam SS. The role of transvaginal ultrasonography and colour Doppler imaging in the detection of ec-pic pregnancy. J Obstet Gynaecol Res. 1996;22(5):455-60.

Nyberg DA, Hughes MP, Mack LA, Wang KY. Extrauterine findings of ec-pic pregnancy of transvaginal US: importance of echogenic fluid. Radiology. 1991;178(3):823-6.

Fleischer AC, Pennell RG, McKee MS, Worrell JA, Keefe B, Herbert CM, et al. Ec-pic pregnancy: features at transvaginal sonography. Radiology. 1990;174(2):375-8.

Atri M, Leduc C, Gillett P, Bret PM, Reinhold C, Kintzen G, et al. Role of endovaginal sonography in the diagnosis and management of ec-pic pregnancy. Radiographics. 1996;16(4):755-74; discussion 75.

Mehta TS, Levine D, McArdle CR. Lack of sensitivity of endometrial thickness in predicting the presence of an ec-pic pregnancy. J Ultrasound Med. 1999;18(2):117-22; quiz 23-4.

Moschos E, Twickler DM. Endometrial thickness predicts intrauterine pregnancy in patients with pregnancy of unknown location. Ultrasound Obstet Gynecol. 2008;32(7):929-34.

Aleem FA, DeFazio M, Gintautas J. Endovaginal sonography for the early diagnosis of intrauterine and ec-pic pregnancies. Hum Reprod. 1990;5(6):755-8.

Ramanan RV, Gajaraj J. Ec-pic pregnancy--the leash sign. A new sign on transvaginal Doppler ultrasound. Acta Radiol. 2006;47(5):529-35.

Szabo I, Csabay L, Belics Z, Fekete T, Papp Z. Assessment of uterine circulation in ec-pic pregnancy by transvaginal color Doppler. Eur J Obstet Gynecol Reprod Biol. 2003;106(2):203-8.

Folkman J, Klagsbrun M. Angiogenic fac-rs. Science. 1987;235(4787):442-7.

Stefanovic V, Caccia-re B, Ylostalo P. Tubal artery blood flow in evaluation of tubal pregnancy. Acta Obstet Gynecol Scand. 1996;75(8):745-7

DOI: http://dx.doi.org/10.22110/jkums.v17i2.1183


  • There are currently no refbacks.

Copyright (c)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.