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Tubal rupture in patients with ectopic pregnancy: diagnosis with transvaginal US.

PURPOSE
To determine whether sonography can help diagnose tubal rupture in patients with ectopic pregnancy.


MATERIALS AND METHODS
The authors reviewed the transvaginal ultrasound (US) scans and medical records of 132 consecutive patients with tubal pregnancy confirmed at surgery performed within 24 hours of undergoing US.


RESULTS
Adnexal masses were seen in 93 patients at US. Thirty-four patients had a tubal ring, and 59 had a complex mass. The frequency of tubal rupture was similar for both groups. The adnexal mass was significantly smaller in patients without a ruptured tube, but there was considerable overlap. Rupture was present in 21% of patients with no sign of or a trace of intraperitoneal fluid, increasing steadily to 63% in patients with a large amount of free fluid. Even though the amount of fluid was the best predictor of rupture, it was not completely reliable, as 37% of patients in whom a large amount of fluid was found had intact tubes.


CONCLUSION
No finding at transvaginal US is a reliable indicator of rupture. Contrary to findings from previous studies, the appearance of the adnexal mass, if present, is not related to tubal rupture.