Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
J Ultrasound Med. 2013 Mar;32(3):389-93. doi: 10.7863/jum.2013.32.3.389.
To determine the incidence of intrauterine fluid in patients with ectopic pregnancy and to define the characteristics that distinguish this fluid from an early intrauterine gestational sac.
We identified all patients scanned transvaginally at our institution from July 2008 through August 2011 for suspected ectopic pregnancy, who proved to have ectopic pregnancy based on pathologic, surgical, or adnexal sonographic findings. We reviewed the sonograms to characterize any fluid in the uterus as to shape, contents, and location. Fluid was classified as type A if it was pointy edged, contained echoes, and/or was clearly located within the uterine cavity or type B if it was smooth walled and anechoic and location was in the decidua or uncertain. The appearance of type A fluid is inconsistent with a gestational sac, while the appearance of type B overlaps that of a gestational sac.
Our study population included 229 women with ectopic pregnancy. In 38 (16.6%), sonography showed fluid in the uterus, which was classified as type A in 31 and type B in 7. Only 2 patients (0.9%) had type B fluid with no adnexal findings suggestive of ectopic pregnancy. Based on these results and the published incidence of ectopic pregnancy (2% of all pregnancies), we calculated that a patient with a positive pregnancy test, an intrauterine smooth-walled anechoic cystic structure, and no adnexal mass has a 0.02% probability of ectopic pregnancy, while the probability of intrauterine pregnancy in such a patient is 99.98%.
Fluid can be seen in the uterus in 16.6% of patients with ectopic pregnancy. On transvaginal sonography, it can be distinguished from an early intrauterine gestational sac based on shape, contents, and/or location in most cases. In the remaining cases, the fluid appears indistinguishable from, and is highly likely to represent, an early intrauterine gestation.
确定异位妊娠患者子宫内积液的发生率，并确定将这种液体与早期宫内妊娠囊区分开来的特征。
我们从 2008 年 7 月至 2011 年 8 月对我院所有疑似异位妊娠的患者进行经阴道超声扫描，根据病理、手术或附件超声结果证实为异位妊娠。我们回顾了这些超声图像，以确定子宫内任何液体的形状、内容和位置。如果液体呈尖锐边缘、含有回声且/或明确位于子宫腔内，则将其分类为 A 型；如果液体呈光滑壁且无回声且位于蜕膜内或位置不确定，则将其分类为 B 型。A 型液体的外观与妊娠囊不一致，而 B 型液体的外观与妊娠囊重叠。
我们的研究人群包括 229 例异位妊娠患者。在 38 例（16.6%）患者中，超声显示子宫内有液体，其中 31 例为 A 型，7 例为 B 型。只有 2 例（0.9%）患者有 B 型液体，且无附件提示异位妊娠的发现。基于这些结果和已发表的异位妊娠发生率（所有妊娠的 2%），我们计算出在一位有阳性妊娠试验、子宫内光滑壁无回声囊性结构且无附件肿块的患者中，异位妊娠的概率为 0.02%，而该患者宫内妊娠的概率为 99.98%。
在 16.6%的异位妊娠患者中可以在子宫内看到液体。在经阴道超声检查中，它可以根据形状、内容和/或位置在大多数情况下与早期宫内妊娠囊区分开来。在其余病例中，该液体与早期宫内妊娠难以区分，且极有可能代表早期宫内妊娠。
