자궁외임신 의증에 대한 임상 및 초음파적 고찰 : 15 예의 진된 자궁외임신을 중심으로 = The Clinical and Ultrasonic Study of Clinically Suspected Ectopic Pregnancy : Laying Emphasis on 15 Proven Ectopic Pregnancies

다국어 초록 (Multilingual Abstract)

Ectopic pregnancies are unsuccessful pregnancies that result from implantation of ferilized ovum occurring in an aberrant area. Aside from an emergency case, the carly diagnosis of ectopic pregnancy is very difficult partiularly in a case with insidious onset and mild clinical manifestations. Early diagnosis not only reduces the danger, but also simplifies the management of ectopic pregnancy. Ultrasonography has been an indispensable diagnostic tool in Obstetrics and Gynecology. In the author's experience, clinical suspected ectopic pregnancy was one of the common indications for performing ultrasonography. Since Kobayashi et al. reported the appearances of ectopic pregnancy utilizing bistable B-scan ultrasonography, the ultrasonic findings of ectopic pregnancy have been reported by many authors. But, its accuracy and reliability in the diagnosis of ectopic pregnancy are still open to controversy. The authors studied 65 cases of clinically suspected ectopic pregnancy with Picker 80 L gray scale ultrasonography from Aug. 1982 to Jun. 1983. There were 29 confirmed cases, of which 15 were proved to have ectopic pregnancy and 14 were proved to have diseases other than ectopic pregnancy by surgical and histopathological study or by laparoscopy and follow up study. 29 confirmed cases were reviewed. The results were as follows : 1. Among 15 ectopic pregnancies, there were 12 ampullary pregnancies, 2 isthmic pregnancies and 1 interstitial pregnancy. Among 14 cases of no ectopic pregnancy, there were 5 intrauterine pregnancies, 3 myoma uteri, 2 P.I.D., and 1 case of dermoid cyst, cystic teratoma, H-mole and tubal hematoma due to previous tubal ligation, respectively. 2. The age distribution of ectopic pregnancy was from 22 to 41 years. The common clinical manifestations of ectopic pregnancy were lower abdominal pain (73.3%), vaginal spotting or bleeding (73.3%) and amenorrhea (66.7%). 3. Positive result of urine immunologic pregnancy test was 28.6% in ectopic pregnancy. 4. Ultrasonic findings of ectopic pregnancy were as follows ; 1) No intrauterine gestational sac was observed in all cases except 1 interstitial pregnancy. Intrauterine fluid collection was observed in 3 cases. Uterine displacement was observed in 10 cases. 2) Among 5 cases of ruptured tubal pregnancy, we observed predominantly cystic adnexal mass in 3 cases, mixed echogenic adnexal mass in 2 cases, and cul-de-sac fluid in all cases. Among 9 cases of unruptured tubal pregnancy, we observed predominantly cystic adnexal mass in 2 cases, mixed echogenic adnexal mass in 7 cases, and cul-de-sac fluid in 3 cases. 3) An echodense ring like structure was observed outside the uterus in 9 cases of tubal pregnancy. 4) In the case of interstitial pregnancy, eccentrically located gestational sac with overlying thin myomerium was observed within the uterus. 5) Fetal heart activity was noted outside the uterus with real time scanning in only 1 case of ectopic pregnancy. 5. Of 19 sonographically ectopic pregnancies, a correct positive ultrasonic diagnosis was made in 14 cases (73.7%). Of 29 confirmed cases, overall diagnostic accuracy of ultrasound was 79.3%. 6. By demonstrating intrauterine pregnancy or diseases other than ectopic pregnancy such as myonauteri, H-mole or ovarian cyst, ectopic pregnancy was ultrasonically excluded in 10 cases. Among above 10 cases, 1 case of ultrasonically bilateral ovarian cyst was proved to have ruptured tubal pregnancy combined with ovarian cyst. The accuracy of ultrasonic exclusion of ectopic pregnancy was 90%. In the author's experience, ultrasonography was very helpful in the exclusion of ectopic pregnancy.