Transabdominal or Transvaginal Ultrasound?
Date First Published:
June 17, 2005
Last Updated:
July 22, 2005
Report by:
Emma Shawkat, 4th Year Medical Student (Manchester Royal Infirmary)
Search checked by:
John Butler, Manchester Royal Infirmary
Three-Part Question:
In [pregnant women, who present with vaginal bleeding to the A&E department,] is [transabdominal or transvaginal ultrasound] better at [detecting an ectopic pregnancy]?
Clinical Scenario:
A 27 year old women presents to the A&E department with vaginal bleeding. She has a positive pregnancy test, and you wonder what is the best imaging modality to rule out an ectopic pregnancy?
Search Strategy:
Medline 1966-06/05 using the ovid interface
Embase 1980-06/05
CINAHL 1982-06/05
The Cochrane Issue 2, 2005
Embase 1980-06/05
CINAHL 1982-06/05
The Cochrane Issue 2, 2005
Search Details:
({[tubal pregnancy.mp or exp PREGNANCY, TUBAL or ectopic pregnancy or exp PREGNANCY, ECTOPIC or abdominal pregnancy.mp or exp PREGNANCY, ABDOMINAL or extrauterine pregnancy.mp] AND [ultrasound.mp. or exp Ultrasonography or sonography.mp.] AND [transvaginal.mp. or vaginal.mp. or endovaginal.mp.] AND [abdominal.mp. or transabdominal.mp. or transvesical.mp.]} LIMIT to [english language and human])
Cochrane 'ectopic pregnancy' AND 'ultrasound'
Cochrane 'ectopic pregnancy' AND 'ultrasound'
Outcome:
140 papers were found using medline, of which 10 were relevant. No additional papers found by the other datbases.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Transvaginal versus transabdominal sonography in the evaluation of pelvic pathology. Qureshi IA. Ullah H. Akram MH. Ashfaq S. Nayyar S 2004 Jul Pakistan | 100 patients included from 212 referred for pelvic sonography Transabdominal vs transvaginal sonography |
Only abstract available at present. | |||
| Comparison of transvaginal and transabdominal ultrasonography in ectopic pregnancy Athey PA. Lamki N. Matyas MA. Watson AB Jr 1991 Oct Canada | 45 consecutive cases of proven ectopic pregnancy Transvaginal vs transabdominal ultrasonography Gold standard: ectopic pregnancy was pathologically proven |
Diagnostic test study | Ectopic pregnancy (n=45) | TVU superior to TAU in 22 (49%) | Retrospective |
| TVU was inferior to TAU in 3 cases (7%) | |||||
| In 20 cases (44%) findings were similar | |||||
| Transabdominal and transvaginal ultrasonographic diagnosis of ectopic pregnancy: clinical implications Valenzano M. Anserini P. Remorgida V. Brasca A. Centonze A. Costantini S 1991 Switzerland | 35 patients attending an emergency room with a positive pregnancy test and suspected ectopic pregnancy Transabdominal vs transvaginal ultrasonography Gold standard: ectopic pregnancy was proved surgically and confirmed by histology |
Diagnostic test study | Ectopic pregnancy | TVU: Senitivity 88.4%, TAU: Sensitivity 76.9% | |
| TVU missed 1 EP that was detected by TAU | |||||
| Transvaginal versus transabdominal sonography in patients suspected of having ectopic pregnancy. Gramith F. Sirr S. Hollerman J. Hawks L 1991 Jan United States | 47 pregnant patients Transabdominal sonography vs transvaginal sonography |
Only abstract at present Retrospectively |
|||
| Transabdominal and transvaginal ultrasonography in the diagnosis of ectopic pregnancy: a comparative study. Kivikoski AI. Martin CM. Smeltzer JS 1990 Dec United States | 34 patients believed to have ectopic pregnancies, of which 25 had an ectopic pregnancy confirmed Transabdominal and transvaginal ultrasonography Gold standard: Operation |
Diagnostic test study | Gestational sac (highly suspicious for EP) | 68% of cases were found by transabdominal US and in 84% by transvaginal US. 1 case detected by TAU was missed by TVU | Doesn't say if physicians looked at the scans independently |
| A distinct adnexal gestational sac | 32%* seen on transabdominal US and 64%* seen transvaginally. *P<0.01 | ||||
| Diagnosis of ectopic pregnancy: endovaginal vs transabdominal sonography Thorsen MK. Lawson TL. Aiman EJ. Miller DP. McAsey ME. Erickson SJ. Quiroz F. Perret RS 1990 Aug United States | 193 women with the clinical diagnosis of suspected ectopic pregnanc. Transabdominal vs endovaginal sonograms Gold standard: Surgically proved |
Diagnostic test study | IUP (n=83) | Endovaginal all 83, Transabdominal 34 | Scans were interpreted at time of study. |
| Ectopic Pregnancy (n=60) | Endovaginal 23, TAU 13. 3 seen on TAU but not endovaginal | ||||
| Missed abortion blighted ovum (n=14) | Endovaginal 7, TAU 5 | ||||
| Indeterminate | Endovaginal 80 out of 193, TAU 141 out of 193 | ||||
| Comparison of abdominal and vaginal sonography in suspected ectopic pregnancy Cacciatore B. Stenman UH. Ylostalo P 1989 May United States | 100 women suspected of having an ectopic pregnancy Whrn TAU did not show a living fetus vaginal sonography was performed Gold standard: Histological examination of tissue samples obtained by surgery |
Diagnostic test study | Sure IUP; 35 were normal and 26 ended in spontaneous abortion | Vaginal sonography 30, 0 were detected by TAU .P<0.001 One IUP was falsely suspected as being ectopic by both methods | |
| Sure EP N=39 | Vaginal sonography 8 and TAU 0. P<0.05 | ||||
| Comparison of transvaginal and transabdominal sonography in the detection of early pregnancy and its complications Jain KA. Hamper UM. Sanders RC 1988 Dec United States | 90 women with a positive pregnancy test and signs and symptoms of threatened abortion or ectopic pregnancy Endovaginal vs abdominal sonography Gold standard: Surgical exploration and pathologic confirmation |
Diagnostic test study | Ectopic Pregnancy (n=22) | Endovaginal sonography 3, TAU 0 | Knowledge of TAU findings made it easier to interpret endovaginal findings Table of results is confusing |
| Suspected ectopic pregnancy: endovaginal and transvesical US Dashefsky SM. Lyons EA. Levi CS. Lindsay DJ 1988 Oct United States | 53 patients who had a positive pregnancy test finding and who were at risk for ectopic pregnancy. Endovaginal vs transvesical US Gold standard: Clinical or pathological |
Diagnostic test study | Normal IUP (n=19) | Endovaginal 100%, transvesical 58% | 29 Examined retrospectively Physicians were not blinded to the diagnosis |
| Abnormal IUP detected | Endovaginal 44%, transvesical 19% | ||||
| Live ectopic pregnancy (n=18) | Endovaginal: accuracy 72%, sensitivity 17%, specificity 100% Transvesical: accuracy 68%, sensitivity 6% and specificity 100% | ||||
| No IUP | Endovaginal: accuracy 83%*, sensitivity 100% and specificity 74% Transvesical: accuracy 60%*, sensitivity 100% and specificity 40%. *P<0.001, Mcnemar test (n=53) | ||||
| Complicated first-trimester pregnancies: evaluation with endovaginal US versus transabdominal technique. Pennell RG. Baltarowich OH. Kurtz AB. Vilaro MM. Rifkin MD. Needleman L. Mitchell DG. Mervis SA. Goldberg BB 1987 Oct United States | 38 pregnant women with clinical complications, at 5-12 weeks pregnant When TAU was inconclusive endovaginal ultrasound was performed Gold standard: Clinically proven |
Diagnostic test study | Ectopic Pregnancy (n=6) | Extrauterine sac seen in 3 case endovaginally but absence of intrauterine gestational sac seen in all 6 cases. For TAU it was 2 and 4 respectively. | Did not state what findings would allow a definate diagnosis of either an IUP or EP |
Author Commentary:
All the papers included used a relatively small sample size, however, they were all in accordance with each other. Occasionally some ectopic pregnancies were detected by transabdominal ultrasound that were missed by transvaginal ultrasound. This did not happen very often.
Bottom Line:
Transvaginal ultrasound is more sensitive than transabdominal ultrasound at detecting an ectopic pregnancy.
References:
- Qureshi IA. Ullah H. Akram MH. Ashfaq S. Nayyar S. Transvaginal versus transabdominal sonography in the evaluation of pelvic pathology.
- Athey PA. Lamki N. Matyas MA. Watson AB Jr. Comparison of transvaginal and transabdominal ultrasonography in ectopic pregnancy
- Valenzano M. Anserini P. Remorgida V. Brasca A. Centonze A. Costantini S. Transabdominal and transvaginal ultrasonographic diagnosis of ectopic pregnancy: clinical implications
- Gramith F. Sirr S. Hollerman J. Hawks L. Transvaginal versus transabdominal sonography in patients suspected of having ectopic pregnancy.
- Kivikoski AI. Martin CM. Smeltzer JS. Transabdominal and transvaginal ultrasonography in the diagnosis of ectopic pregnancy: a comparative study.
- Thorsen MK. Lawson TL. Aiman EJ. Miller DP. McAsey ME. Erickson SJ. Quiroz F. Perret RS. Diagnosis of ectopic pregnancy: endovaginal vs transabdominal sonography
- Cacciatore B. Stenman UH. Ylostalo P. Comparison of abdominal and vaginal sonography in suspected ectopic pregnancy
- Jain KA. Hamper UM. Sanders RC. Comparison of transvaginal and transabdominal sonography in the detection of early pregnancy and its complications
- Dashefsky SM. Lyons EA. Levi CS. Lindsay DJ. Suspected ectopic pregnancy: endovaginal and transvesical US
- Pennell RG. Baltarowich OH. Kurtz AB. Vilaro MM. Rifkin MD. Needleman L. Mitchell DG. Mervis SA. Goldberg BB. Complicated first-trimester pregnancies: evaluation with endovaginal US versus transabdominal technique.