[What is the predictive value of ultrasound diagnosis in suspected extra-uterine pregnancy in routine clinical practice?].

In this retrospective study the data of 340 patients who underwent invasive diagnostics in suspected ectopic pregnancy from 1985 to 1991 are being analyzed. The aim of this study is to examine the prognostic value of ultrasonic findings after the introduction of transvaginal sonography and highly sensitive urine pregnancy tests in the every day clinical routine. In transvaginal ultrasound significantly more direct signs of an ectopic pregnancy than in the abdominal technique were found showing a markedly higher positive predictive value: 93.5% for an extrauterine double ring, 90.7% for inhomogeneous adnexal masses with the simultaneous finding of echogenic fluid in the pouch of Douglas and 79.3% for isolated inhomogeneous adnexal masses. The predictive values for indirect sonographic hints of suspected extrauterine gravidity were 78.4% for an empty uterine cavity and 87.3% for echogenic fluid in the pouch of Douglas. With growing experience in the vaginal ultrasound technique the positive predictive values of all these signs reached 91% to 98%. Additionally the rate of false-negative urine pregnancy tests in patients with ectopic pregnancy sank with increasing sensitivity from 49% (1000 IU HCG/l) to 3.2% (50 IU/l). Summarizing all these factors the reliability of conservative diagnostic means in suspected ectopic pregnancy raised considerably from 56.4% to 94.3% during the course of our study.