Ultrasound in low-lying implantation ectopic pregnancy diagnosis at early gestational age

For assessing the diagnostic value of ultrasound signs of low-lying implantation ectopic pregnancy at early gestational age retrospective study was performed. Retrospective examination of images and medical records of 37 patients with low-lying implantation ectopic pregnancy (main group) was done. The control group was formed from 50 patients with intrauterine pregnancy. We assessed gestational sac location (according to I.E. Timor-Tritsch et al., 2016), cervical length, location of the most distant edge of gestational sac in relation to the internal cervical os, myometrial thickness of anterior uterine wall before 8 gestational week, and number of the previous caesarean deliveries. In the main group gestational sac center in 26 out of 37 cases (70.3%) was located lower than midpoint axis of the uterus while in the control group it was registered in 11 out of 50 cases (22.0%) (P < 0.000). In the main group the most distant edge of gestational sac was located lower than the internal cervical os (category 2) in 9 out of 37 cases (24.3%), at the internal cervical os level (category 1) in 19 (51.4%) cases, and higher than the internal cervical os (category 0) in 9 (24.3%) cases. In the control group category 1 was registered in 4 (8.0%) patients, category 0 - in 46 (92.0%) patients (P < 0.000). Cervical length and myometrial thickness of anterior uterine wall were significantly lower in the main group when compared with the control group (P = 0.022 and 0.035, respectively). Number of the previous caesarean deliveries in the main group was significantly higher when compared with the control group (48.6% (18) versus 16.0% (8)) (P = 0.002). For the diagnostic test «location of the most distant edge of gestational sac is lower than the internal cervical os or at the internal cervical os level (categories 1 and 2) in low-lying implantation ectopic pregnancy diagnosis before 8 weeks of gestation» sensitivity was 75.7%, specificity - 92.2%, AUC - 0.849. For the diagnostic test “location of gestational sac center is lower than midpoint axis of the uterus in low-lying implantation ectopic pregnancy diagnosis before 8 weeks of gestation” sensitivity was 70.3%, specificity - 78.8%, AUC - 0.746.

ультразвуковая диагностика, эктопическая беременность при низкой имплантации плодного яйца, беременность в рубце после кесарева сечения, шеечно-перешеечная беременность, ранние сроки гестации, ultrasound, low-lying implantation ectopic pregnancy, cesarean scar pregnancy, cervicoisthmic pregnancy, early gestational age

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