CORRELATION AND DIAGNOSTIC ACCURACY OF TRANSABDOMINAL AND TRANSVAGINAL SONOGRAPHY IN SUSPECTED ECTOPIC PREGNANCY
Keywords:
ectopic pregnancy, Transabdominal Sonography, Transvaginal Sonography, accuracy, sensitivity, specificity, pelvic ultrasound.Abstract
Background: Ectopic pregnancy (EP), the condition of implantation of the blastocyst outside the uterine cavity, is an emergent condition during first-trimester obstetric complications and has a high risk to mortality and causes failure on falling tubes, large hemoperitoneum and death. In timely and early diagnosed, the imaging modalities (TAMS and TVS) are used, where sonography plays the primary imaging role.
Objectives: To assess the correlation and diagnostic accuracy of transabdominal and transvaginal sonography in women with suspected ectopic pregnancy.
Methods: An analytical comparative cross-sectional study was designed by Department of Radiology Central Park Teaching Hospital, Lahore among pregnant women aged 18-45 years with positive pregnancy test and signs/symptoms suspected EP. 80 females had been selected by non-probability purposive sampling technique on clinical and obstetric ground for each patient who were investigated for both TAS and TVS simultaneously by an experienced radiologist consecutively. For diagnosis purpose the final decision criterion or Gold standard criterion determined after performing the surgical and clinical /pathological finding. The data was processed using SPSS version 25. The diagnostic variables, the values of Kappa coefficient and McNemar test.
Results: 14 (17.5%) females had confirmed EPs, among 80 pregnant females and 66 (82.5%) patients were of intra-uterine pregnancy (IUP) with clinical symptoms of vaginitis, dyspareunia, abdominal pain, vaginal bleeding, etc are significant variables to define EP (P < 0.001). Using TAS, sensitivity 92.9% (13/14), specificity 100% (66/66), PPV 100%, NPV 98.5%, diagnostic accuracy was 98.8%. TVS results shows sensitivity 100% (14/14), specificity 100% (66/66), PPV 100%, NPV 100%, diagnostic accuracy was 100%. Near perfect correlation between TAS & TVS (Kappa=0.955, p < 0.001). TAS couldn't pick early ET due to gestational age and it was seen on TVS scan (1 case).
Conclusion: Both TAS and TVS are good to high for detection of ET. But TVS shows better results to determine sensitivity for very early diagnosis of ET. TAS can act as an adjunctive modality. It can easily be utilized to see widespread free fluid and also provide good look of pelvis at large with large window.
