Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 13 , ISSUE 4 ( October-December, 2019 ) > List of Articles


Three-dimensional Ultrasound Imaging in the Diagnosis of Ectopic Pregnancy

Ulrich Honemeyer

Keywords : 3D ultrasound, Color/power Doppler, Ectopic pregnancy, Tomographic ultrasound imaging.

Citation Information : Honemeyer U. Three-dimensional Ultrasound Imaging in the Diagnosis of Ectopic Pregnancy. Donald School J Ultrasound Obstet Gynecol 2019; 13 (4):181-192.

DOI: 10.5005/jp-journals-10009-1605

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2019; The Author(s).


Morbidity and mortality of ectopic pregnancy (EP) have been drastically reduced since the first successful surgical removal of a fallopian tube EP in 1884 by Tait. Diagnosis and treatment were revolutionized by the introduction of quantitative serum beta hCG essay, high frequency transvaginal ultrasound (TVS), laparoscopic surgery, and interventional radiology with uterine artery embolization (UAE). In this paper, the focus will be on TVS diagnosis of EP in various locations. With two-dimensional (2D) color Doppler TVS having established itself as state-of-the-art diagnostic tool for EP, it will be discussed whether the additional use of 3-dimensional (3D) TVS facilitates the diagnosis of EP.

  1. Van Den Eeden SK, Shan J, Bruce C, et al. Ectopic pregnancy rate and treatment utilization in a large managed care organization. Obstet Gynecol 2005;105(5 Pt 1):1052. DOI: 10.1097/01.AOG.0000158860.26939.2d.
  2. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol 2010;115(3):495. DOI: 10.1097/AOG.0b013e3181d0c328.
  3. Stulberg DB, Cain LR, Dahlquist I, et al. Ectopic pregnancy rates and racial disparities in the Medicaid population, 2004-2008. Fertil Steril 2014;102(6):1671. DOI: 10.1016/j.fertnstert.2014.08.031.
  4. Murray H, Baakdah H, Bardell T, et al. Diagnosis and treatment of ectopic pregnancy. CMAJ 2005;173(8):905. DOI: 10.1503/cmaj.050222.
  5. Creanga AA, Shapiro-Mendoza CK, Bish CL, et al. Trends in ectopic pregnancy mortality in the United States: 1980–2007. Obstet Gynecol 2011;117(4):837–843. DOI: 10.1097/AOG.0b013e3182113c10.
  6. Der EM, Moyer C, Gyasi RK, et al. Pregnancy related causes of deaths in Ghana: a 5-year retrospective study. Ghana Med J 2013;47(4):158–163.
  7. Iklaki CU, Emechebe C, Njoku CO, et al. Review of Ectopic Pregnancy as a Cause of Maternal Morbidity and Mortality in a Developing Country. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 2015;14(8):86–91. e-ISSN: 2279-0853, p-ISSN: 2279-0861.
  8. Brüggmann D, Kollascheck J, Quarcoo D, et al. Ectopic pregnancy: exploration of its global research architecture using density-equalising mapping and socioeconomic benchmarks. BMJ Open 2017;7(10):e018394. DOI: 10.1136/bmjopen-2017-018394.
  9. Ouyang Y, Li X, Yi Y, et al. First-trimester diagnosis and management of Cesarean scar pregnancies after in vitro fertilization-embryo transfer: a retrospective clinical analysis of 12 cases. Reprod Biol Endocrinol 2015;13:126. DOI: 10.1186/s12958-015-0120-2.
  10., HealthDirect, a free medical service supported by the Australian government.
  11. Winder S, Reid S, Condous G. Ultrasound diagnosis of ectopic pregnancy. AJUM 2011;14(2):29–33. DOI: 10.1002/j.2205-0140.2011.tb00192.x.
  12. Tait RL. Five cases of extrauterine pregnancy operated upon at the time of rupture. Br Med J 1884;1:1250. DOI: 10.1136/bmj.1.1226.1250.
  13. Kalk H. Erfahrungen mit der Laparoskopie (zugleich mit Beschreibung eines neuen Instrumentes). Z Klin Med 1929;111:303.
  14. Hope RB. Differential diagnosis of ectopic gestation by peritonoscopy. Surg Gynecol Obstet 1937;64:229.
  15. Donald I, Macvikar MB, Brown TG. Investigation of abdominal masses by pulsed ultrasound. The Lancet 1958;271(7032):1188–1195. DOI: 10.1016/S0140-6736(58)91905-6.
  16. Timor-Tritsch IE, Farine D, Rosen MG. A close look at early embryonic development with the high-frequency transvaginal transducer. Am J Obstet Gynecol 1988;159(3):676–681. DOI: 10.1016/S0002-9378(88)80033-4.
  17. Kurjak A, Jurkovic D, Alfirevic Z, et al. Transvaginal color Doppler imaging. J Clin Ultrasound 1990;18(4):227–234.
  18. Armstrong E, Ehrlich P, Birken S, et al. Use of a highly sensitive and specific immunoradiometric assay for detection of human chorionic gonadotropin in urine of normal, nonpregnant, and pregnant individuals. J Clin Endocrinol Metab 1984;59(5):867–874. DOI: 10.1210/jcem-59-5-867.
  19. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom, 2011.
  20. Lurie S. The history of the diagnosis and treatment of ectopic pregnancy: a medical adventure. Eur J Obstet Gynecol Reprod Biol 1992;43(1):1–7. DOI: 10.1016/0028-2243(92)90235-Q.
  21. The Institute of Obstetricians and Gynecologists, Royal College of Physicians in Ireland, and Directorate of Clinical Strategies and Programmes, Health Service Executive. Clinical Practice Guideline–The Diagnosis and Management of Ectopic Pregnancy. Version: 1.0 Guideline No: 33; Publication Date Nov. 2014, Revision Date Nov. 2017.
  22. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2016. Atlanta, GA: US Department of Health and Human Services; 2017.
  23. Centers for Disease Control and Prevention, Births - Method of delivery, 2015. (accessed on May 05, 2017).
  24. Li C, Zhao WH, Zhu Q, et al. Risk factors for ectopic pregnancy: a multi-center case-control study. BMC Pregnancy Childbirth 2015;15:187. DOI: 10.1186/s12884-015-0613-1.
  25. Steptoe PC, Edwards RG. Reimplantation of the human embryo with subsequent tubal pregnancy. Lancet 1976;1:880–882. DOI: 10.1016/S0140-6736(76)92096-1.
  26. Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 2002;17(12):3224–3230. DOI: 10.1093/humrep/17.12.3224.
  27. Tulandi T, Al-Jaroudi D. Interstitial pregnancy: results generated from the Society of Reproductive Surgeons registry. Obstet Gynecol 2004;103(1):47–50. DOI: 10.1097/01.AOG.0000109218.24211.79.
  28. Seo MR, Choi SC, Bae J, et al. Preoperative diagnostic clues to ovarian pregnancy: retrospective chart review of women with ovarian and tubal pregnancy. Obstet Gynecol Sci 2017;60(5):462–468. DOI: 10.5468/ogs.2017.60.5.462.
  29. Fylstra DL. Ectopic pregnancy not within the (distal) fallopian tube: etiology, diagnosis, and treatment. Am J Obstet Gynecol 2012;206(4):289–299.
  30. Comstock C, Huston K, Lee W. The ultrasonographic appearance of ovarian ectopic pregnancies. Obstet Gynecol 2005;105(1):42–45. DOI: 10.1097/01.AOG.0000148271.27446.30.
  31. Ghi T, Banfi A, Marconi R, et al. Picture of the month-three dimensional sonographic diagnosis of ovarian pregnancy. Ultrasound Obstet Gynecol 2005;26(1):102–104. DOI: 10.1002/uog.1933.
  32. Lau S, Tulandi T. Conservative medical and surgical management of interstitial ectopic pregnancy. Fertil Steril 1999;72(2):207–215. DOI: 10.1016/S0015-0282(99)00242-3.
  33. Yassin AS, Taha MS. Interstitial ectopic pregnancy, diagnosis and management: A case report and literature review. Ann Clin Case Rep 2017;2:1352. ISSN: 2474-1655.
  34. Kao LY, Scheinfeld MH, Chernyac V, et al. Beyond ultrasound: CT and MRI of ectopic pregnancy. AJR Am J Roentgenol 2014;202(4):904–911. DOI: 10.2214/AJR.13.10644.
  35. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007;114(3):253–263. DOI: 10.1111/j.1471-0528.2006.01237.x.
  36. Shih J-C. Cesarean scar pregnancy: diagnosis with 3-dimensional (3D) ultrasound and 3 D power Doppler. Ultrasound Obstet Gynecol 2004;23(3):305–309. DOI: 10.1002/uog.1005.
  37. Ruano R, Reya F, Picone O, et al. Three-dimensional ultrasonographic diagnosis of a cervical pregnancy. Clinics (Sao Paulo) 2006;61(4): 355–358. DOI: 10.1590/S1807-59322006000400014.
  38. Lau WL, Cahn LL, Chan KS, et al., 3D ultrasound diagnosis of the cervical pregnancy.2011-2-23.
  39. Ahmed AA, Brian DM, Calabrese P. Ectopic pregnancy and pseudo-sac. Fertil Steril 2004;81(5):1225–1228. DOI: 10.1016/j.fertnstert.2003.09.068.
  40. Rubal L, Chang K. Do you need to definitely diagnose the location of a pregnancy of unknown location? The case for “yes”. Fertil Steril 2012;98(5):1078–1084. DOI: 10.1016/j.fertnstert.2012.09.033.
  41. Reid S, Condous G. Is there a need to definitely diagnose the location of a pregnancy of unknown location? The case for “no”. Fertil Steril 2012;98(5):1085–1090. DOI: 10.1016/j.fertnstert.2012.09.032.
  42. Parekh VK, Bhatt S, Dogra VS. Abdominal pregnancy: an unusual presentation. J Ultrasound Med 2008;27(4):679–681. DOI: 10.7863/jum.2008.27.4.679.
  43. Abduljabbar N, Saquib S, Elhussein W. Successful management of abdominal pregnancy: two case reports. Oman Med J 2018;33(2): 171–175. DOI: 10.5001/omj.2018.32.
  44. Gibbs RS. Danforth's obstetrics and gynecology, 10th ed. Philadelphia: Lippincott Williams & Wilkins; 2008; p. 84.
  45. Atrash HK, Friede A, Hogue CJ. Abdominal pregnancy in the United States: frequency and maternal mortality. Obstet Gynecol 1987; 69(3 Pt 1):333–337.
  46. Infante F, Espada Vaquero M, Bignardi T, et al. Prediction of tubal ectopic pregnancy using offline of 3-dimensional transvaginal ultrasonographic data sets: an interobserver and diagnostic accuracy study. J Ultrasound Med 2018;37(6):1467–1472. DOI: 10.1002/jum.14489.
  47. Testa AC, Van Holsbeke C, Mascilini F, et al. Dynamic and interactive gynecological ultrasound examination. Ultrasound Obstet Gynecol 2009;34(2):225–229. DOI: 10.1002/uog.7309.
  48. Braunstein GD, Vaitukaitis JL, Carbone PP, et al. Ectopic production of human chorionic gonadotropin by neoplasms. Ann Intern Med 1973;78(1):39. DOI: 10.7326/0003-4819-78-1-39.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.