Value of transvaginal sonography in diagnosing heterotopic pregnancy after in-vitro fertilization with embryo transfer.

OBJECTIVES

To assess the value of transvaginal sonography (TVS) in the diagnosis of heterotopic pregnancy (HP) in the first trimester after in-vitro fertilization with embryo transfer (IVF-ET).

METHODS

This was a retrospective review of women undergoing IVF-ET between January 2005 and December 2011. Women were diagnosed with an HP using TVS if a visible intrauterine gestational sac was observed with any of the following: (i) an inhomogeneous adnexal mass; (ii) an empty extrauterine gestational sac seen as a hyperechoic ring; or (iii) a yolk sac and/or fetal pole with or without cardiac activity in an extrauterine sac.

RESULTS

Overall, 16 483 consecutive women who underwent IVF had TVS during the study. Of these, 174 cases were diagnosed on TVS as having an HP, and 10 cases were missed. Fifty-two cases were treated expectantly and were excluded from the analysis. Three types of ultrasonographic presentation of ectopic pregnancy (EP) were seen in HP patients, with a gestational sac found in 70 cases, a ring sign in 21 and an adnexal mass in 31. The sensitivity and specificity of TVS for the detection of HP were 92.4 and 100%, respectively, with positive and negative predictive values of 100 and 99.9%. The HP cases comprised 103 tubal EPs and 29 non-tubal EPs. In 93 patients (70.5%), their intrauterine pregnancy resulted in a live birth, 37 patients (28.0%) suffered an early miscarriage and two patients (1.5%) had a late miscarriage.

CONCLUSION

Early TVS performed by an experienced sonographer has a high sensitivity for making the correct diagnosis of HP after IVF-ET.