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38 cases of ultrasound diagnosis of ectopic pregnancy_2735

By Jeremy Smith,2014-10-30 07:49
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38 cases of ultrasound diagnosis of ectopic pregnancy_2735

38 cases of ultrasound diagnosis of ectopic pregnancy

     Abstract Objective To investigate the value of ultrasound diagnosis of ectopic pregnancy and misdiagnosis. Methods A retrospective analysis of 38 pathologically proved cases of ectopic pregnancy in patients with

    Ultrasonographic characteristics. Results 38 cases of ectopic pregnancy patients diagnosed 34 cases, diagnostic accuracy rate of 89.5%. Conclusion The diagnosis of ectopic pregnancy, ultrasound is a simple and effective method is the preferred imaging method.

     Key words ectopic pregnancy; ultrasound; Diagnosis

     Abstract Objective To study the value of ectopic pregnancy with ultrasonography and to analyze the causes of misdiagnosis. Methods Ultrasonic characteristics of 38 ectopic pregnancy cases wich were

    confirmed by surgery and pathology were retrospectively analyzed, and to study the value of ultrasonography. Results 34 cases were confirmed by means of ultrasonography among 38 patients, and the diagnostic coincidence

    rate was 89.5%. Conclusion Ultrasonography is very simple and effective in the diagnosis of ectopic pregnancy, and it is the first choice to detect ectopic pregnancy.

     Key words ectopic pregnancy; ultrasonography; diagnosis

     Ectopic pregnancy is a common gynecological acute abdomen disease, its incidence in recent years, an upward trend [1], large frequently occurring dangerous, and some are not typical, or early symptoms, or was old. Early diagnosis, early treatment is conducive to choose the best treatment

    options, to retain reproductive function and reduce complications are of great significance. The author's hospital after surgery and pathology confirmed 38 cases of ectopic pregnancy in patients with ultrasound data were analyzed retrospectively.

     1 Data and methods

     1.1 General Information

     The group of 38 patients in October 2004 ~ November 2007 hospital in-

    patients, aged 18 to 45 years with an average age of 31 years. 33 cases had the history of menopause, menopause 35 ~ 64 d, 5 Li menstrual history

    is unknown, 34 cases of irregular vaginal bleeding, abdominal pain 35 cases, 33 cases of urinary HCG-positive, weakly positive in 3 cases,

    negative in 2 cases.

     1.2 Instruments and methods

     The Canadian Ultrasonx ES 500-mode color Doppler ultrasonic

    diagnostic apparatus, abdominal probe frequency of 3.5 ~ 5.0MHz, intracavitary probe frequency of 5.0 ~ 7.0MHz. Patient was supine position, and first abdominal scanning to understand the uterine size, endometrial and the IUD were observed around the attachment area for lumps uterus, pelvis, upper abdominal liver and kidney, spleen and whether there is free liquid clearance; if not satisfied by abdominal ultrasound, using transvaginal ultrasound examination; if found Package blocks, with color

    Doppler shows mass flow for Doppler frequency spectrum analysis, to detect arterial blood flow velocity and resistance index.

     2 Results

     The patients were confirmed by surgery and pathology, of which 29 patients with abdominal ultrasonography confirmed that five cases of transvaginal ultrasound examination to determine, diagnostic accuracy rate of 89.5%. Of these, three cases of pregnancy by ultrasonography and to see a little embryo sac, 2 See, for example primitive heart tube pulse, 31

    patients were found behind the attachment area or uterine mixed clumps, clumps of 26 cases of peripheral and internal flow rich, 21 were detected to high speed and low resistance artery blood flow signal (RI0.35

    0.48), 25 cases with pots / peritoneal effusion. Missed and delayed

    diagnosis in 4 cases, accounting for 10.5%. Including the extrauterine no mass, intra-uterine pregnancy sac misdiagnosed as pseudo-one cases of

    intra-uterine pregnancy, intrauterine ectopic pregnancy at the same time

    one cases of missed diagnosis of ectopic pregnancy, old ectopic pregnancy misdiagnosed as pelvic inflammatory mass in 1, old of ectopic pregnancy misdiagnosed as ovarian cyst and solid mass in 1 case. Reposted elsewhere in the paper for free download http://

     3 Discussion

     Yunluan planted in the uterus or womb anomalies outside the area, saying that ectopic pregnancy or ectopic pregnancy. Frequently there is

    tubal pregnancy, ovarian pregnancy, abdominal pregnancy, in order to tubal pregnancy common, accounting for about 95% [2]. In recent years, due to an increase in infectious diseases, the widespread use of IUD, repeated abortion and drug flow and an increase in cesarean section and other factors, the incidence of ectopic pregnancy on the rise.

     Currently, ultrasound imaging is recognized as the preferred diagnostic method. Diagnosis rate in this group 89.5%, of which 29 cases were diagnosed with abdominal ultrasound; this group, five cases of abdominal ultrasonography showed dissatisfaction with transvaginal

    ultrasound diagnosis. Ultrasonography was found pregnant and extrauterine sac containing the embryo and the primitive heart tube pulsation, can be diagnosed. However, such clinical cases of rare, only 2 cases in this group. Most of ectopic pregnancy sonogram showed mass type, including abortion, ruptured and unruptured. Abortion ruptured patients can see the size of the search in the Annex area ranging from mixed clumps of irregular shape, internal echo uneven pregnancy sac showed unclear, pots /

    peritoneal fluid within the dark area, combined with menopause, and HCG-

    positive , diagnosis of these ectopic pregnancies is not difficult. For the non-ruptured and can not make judgments alone sonogram, color Doppler flow imaging in detection of gestational trophoblastic blood flow, relying solely on black and white will help greatly enhance the accuracy of ultrasound diagnosis of ectopic pregnancy in this group of 21 cases of peripheral clumps and internal exploration and high-speed low resistance

    artery blood flow signal (RI0.35 0.48). To realize that in unruptured

    ectopic pregnancy diagnosis, should be a careful analysis of sonographic features, detailed history, clinical manifestations and HCG in conjunction with the inspection, reduce misdiagnosis.

     For some the lack of typical audio and video easily mistaken for ectopic pregnancy ultrasound missed, 4 cases of misdiagnosis in this group, as follows: 1 cases of extrauterine no mass, intra-uterine

    pregnancy misdiagnosed as false pregnancy sac sac, line curettage

    pathologic Check no villi. Intrauterine gestational sac gestational sac and the differential diagnosis of pseudo-pseudo-pregnancy sac in the

    uterine cavity is the central ring unparalleled change. The early pregnancy sac in the uterus often tend to side of the attachment wall thick, showing double-loop syndrome [3]. 1 cases of pregnancy sac

    ultrasound investigations, see, germ, and primitive heart tube pulsation, because the patient had clothes lines curettages other drugs. After 4 days

    the patient sudden lower abdominal pain and vaginal bleeding, ultrasound examination, see the left side of the annex has a mixed clumps, uterus rectum pits a large number of fluid, the uterus was floating like to change. Confirmed after rupture of tubal pregnancy. Missed diagnosis of this case is only noted that intra-uterine pregnancy, did not carefully

    observe the attachment situation, coupled with unruptured ectopic pregnancy before the non-typical audio-visual, did not take into account

    intrauterine ectopic pregnancy may be at the same time. 2 cases of ectopic pregnancy misdiagnosed as pelvic inflammatory disease of old mass in 1 patient misdiagnosed as ovarian cyst and solid mass in 1 case, The reason is mainly the incidence for a long time to change the lack of specificity

of sonography, annex area lumps form is not regulation, boundary

    ambiguity, its internal structure, messy, pregnancy sac showed unclear, urine HCG was negative, the misconception that menstrual bleeding, so old a high rate of misdiagnosis of ectopic pregnancy, the diagnosis is often difficult , urine HCG was negative, and can not rule out ectopic

    pregnancy.

     In conclusion, ultrasound diagnosis of ectopic pregnancy is a simple and effective method, but there is still ultrasound in the first diagnosis of clinical misdiagnosis of ectopic pregnancy, with urine HCG, detailed

    history, can improve the diagnosis of ectopic pregnancy level.

     References

     [1] Lehner R, kucera E, Jirecek S. Ectopic Pregnancy [J]. Arch Gynecol Obstet, 2000, 263: 87 92.

     [2] ZHOU Yong-chang, GUO Wan-learning. Ultrasonics (the book) [M]. 4th

    edition. Beijing: Science and Technology Literature Publishing House, 2003:1 394 1 395.

     [3] Wang Jun, Lu Shu-Kun. Ectopic pregnancy with intrauterine pregnancy sac off early ultrasound [J]. Chinese Journal of Ultrasound Medicine, 2004, 4 (7): 556. Reposted elsewhere in the paper for free download http : / /

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