Can transvaginal ultrasound detect an ectopic pregnancy?

The article is professionally consulted by Master, Doctor Ly Thi Thanh Nha - Department of Obstetrics and Gynecology - Vinmec International General Hospital Da Nang. Doctor Nha has strengths and experience in fetal malformation ultrasound, 3D, 4D fetal ultrasound.

1.1 What is an ectopic pregnancy? An ectopic pregnancy is a condition in which a fertilized egg implants but is outside its normal position (endometrium). The most common ectopic pregnancy is in a fallopian tube (commonly known as an intra-tubal pregnancy). However, ectopic pregnancy can also appear in other locations such as the ovary, cervix, abdomen,... According to statistics, there are about 1-2% of ectopic pregnancies.
In most cases, an ectopic pregnancy cannot develop normally outside the uterus. As a result, the embryo or fetus dies or causes internal bleeding of varying degrees for the pregnant woman.
Symptoms of ectopic pregnancy include:
Abdominal pain; No menstrual period Vaginal bleeding or bleeding from time to time, intermittently; Other symptoms: Nausea, breast discomfort; When an ectopic pregnancy ruptures: Fatigue, dizziness due to severe internal bleeding, low blood pressure; Shock: low blood pressure, weakness, rapid pulse, pale skin,... Factors that increase the risk of ectopic pregnancy include: Age (woman 35 - 44 years old), medical history (people who have had an ectopic pregnancy in the past) uterus), structural damage to the Fallopian tube due to congenital or previous gynecological surgery, infection, multiple sex partners, gynecological diseases (endometritis, fibroids, pelvic scar tissue) , using an IUD, smoking, infertility,...

1.2 What is transducer ultrasound? Transducer ultrasound is an imaging method that is being widely applied with high accuracy. The technique is performed with a specialized ultrasound probe, allowing the doctor to evaluate and detect abnormal signs in the uterus and ovaries, check the thickness of the uterine lining, evaluate the ovulation, the development of the uterus. egg development, tubal fluid stasis, appendicitis,... In addition, this method is also valuable in early pregnancy diagnosis, examination, and support for treatment of infertility and infertility. ..
The advantage of transducer ultrasound is that it helps doctors see more clearly the genital organs located in the body, easily detects pathologies in the pelvic region that are often difficult to see with abdominal ultrasound. . The limitation of this method is that it is difficult to visualize the higher layers of the abdomen.

For women who are pregnant, transducer ultrasound is very necessary and has an important effect in recognizing pregnancy in the early stages (when the embryo is very small, not showing images if only ultrasound is used). abdominal wall).
With other groups of women, transducer ultrasound is indicated when there are signs of ectopic pregnancy. So can transvaginal ultrasound show an ectopic pregnancy? The answer is yes. During transducer ultrasound, the doctor will determine the exact position of the gestational sac and embryo, helping to detect an ectopic pregnancy. Regarding the technical procedure, the doctor will insert a small, long probe into the vagina, allowing to locate the implantation position of the fetus, closely observe the uterus, ovaries and fallopian tubes. This is a very important diagnosis in the prevention of complications of ectopic pregnancy such as ruptured fallopian tubes, abdominal infections,...

In addition, other testing methods such as beta-hCG quantification and blood count may be used to confirm the diagnosis.

3.1 Signs of intrauterine pregnancy Transvaginal ultrasound has the ability to accurately differentiate between normal intrauterine pregnancy, abnormal intrauterine pregnancy, and ectopic pregnancy. Transducer ultrasound can detect a gestational sac in the uterus with a size of 2 - 4 mm, equivalent to a 33 - 34 day old fetus (since the last menstrual period).
True gestational sac: Asymmetrically located in the uterine cavity, there is a double gestational sac made up of the parietal decidua and the decidua. With gestational sac size less than 5mm, there is no image of double gestational sac; False gestational sac: Occurs due to blood stasis in the uterine cavity and the decidual reaction of the endometrium. The false gestational sac is located in the center of the uterus, there is no image of a double gestational sac. For women with an intrauterine pregnancy, the rate of ectopic pregnancy is only 1:6000.
3.2 Signs of parauterine mass A parauterine mass may or may not be an ectopic pregnancy.
Typical picture: The gestational sac is outside the uterus, there are embryos and fetal heart activity, 17 - 21% are definitely diagnosed with ectopic pregnancy; Atypical images: There are images like gestational sac and embryo but no fetal heart activity, only images like gestational sac and yolk sac, empty gestational sac next to the uterus. These cases have not been confirmed as ectopic pregnancy; The mass is located next to the uterus and ovary, with thick echogenic structure, empty or mixed echo: Diagnosis positive 63 - 100%; No parauterine mass found: An ectopic pregnancy cannot be ruled out.

The parauterine mass may be indicated with Doppler ultrasound to increase the diagnostic value of ectopic pregnancy.
Transducer ultrasound is one of the effective, highly accurate and safe ectopic pregnancy diagnosis techniques. Therefore, when there are signs of pregnancy or warning signs of ectopic pregnancy, pregnant women should go to specialized facilities for examination, advice and early detection of fetal abnormalities to take measures. timely remedial measures. The first 3 months are the most sensitive time during pregnancy. In order for mother and baby to be healthy, parents need to pay attention to:
Understand early signs of pregnancy, pregnancy poisoning, bleeding during pregnancy. Timely, correct and sufficient first prenatal check-up, avoiding too early/too late. Fetal malformation screening at 12 weeks detects dangerous fetal malformations that can be intervened early. Distinguish between normal vaginal bleeding and pathological vaginal bleeding for timely intervention to maintain pregnancy. Screening for thyroid disease in the first 3 months of pregnancy avoids dangerous risks before and during delivery. Vinmec currently has many maternity packages (12-27-36 weeks), in which the 12-week maternity package helps monitor the health of mother and baby right from the beginning of pregnancy, early detection and timely intervention of health issues. In addition to the usual services, the maternity monitoring program from 12 weeks has special services that other maternity packages do not have such as: Double Test or Triple Test to screen for fetal malformations; Quantitative angiogenesis factor test for preeclampsia; thyroid screening test; Rubella test; Testing for parasites transmitted from mother to child seriously affects the baby's brain and physical development after birth.
For more information about the 12-week maternity package and registration, you can contact the clinics and hospitals of Vinmec health system nationwide.