Advances in diagnosis and treatment of ectopic pregnancy

Early and reliable diagnosis of ectopic pregnancy still remains a challenge but is essential to avoid life-threating bleeding or consequent infertility. The introduction of transvaginal sonography has improved diagnostic accuracy, but using this technique in about half of ectopic pregnancies an ectopic gestational sac is not clearly visualized. Color Doppler ultrasound contributes to detection of hemoclynamic changes in tubal arteries by enabling demonstration of high vascularity in approximately 94% of ectopic pregnancies. The appearance and the location of the blood flow relate to the gestational sac dimension and flow velocity waveform characteristics and are similar to those obtained from the spiral arteries in normal int-rauterine pregnancies (Rl = 0.42 ± 0.12). Color Doppler studies demonstrate a high quantity of color in ectopic pregnancies with vital trophoblast and/or a live embryo as well as those with relatively high beta hCG levels. Demonstrations of the "hot flow pattern" shortens the diagnostic process and enables an easier clinical decision to be reached on the treatment of ectopic pregnancy. Based on our clinical experience in patients with less color signals and increased vascular resistance to blood flow, both indicating a non-vital trophoblast and/or long-standing xlemise, expectant management can be introduced. Our preminary data suggest that three-dimensional sonography is an effective procedure for early diagnosis of ectopic pregnancies, which enables demostrations of hyperechoic border, an apparently specific feature not reported by conventional ultrasound studies. It seems that shortening diagnostic procedure process and proper selections of the patients based on color Doppler an 3D ultrasound evaluation enables introduction of more sufficient treatment options.