The Journal of Minimally Invasive Gynecology
Volume 17, Issue 6 , Pages 754-759 , November 2010

Culdocentesis Followed by Saline Solution–Enhanced Ultrasonography: Technique for Evaluation of Suspected Ectopic Pregnancy

  • Tamer M. Yalcinkaya, MD

      Affiliations

    • Departments of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • ,
  • Shon P. Rowan, MD

      Affiliations

    • West Virginia University School of Medicine, Morgantown, West Virginia
    • ,
  • Munire Erman Akar, MD

      Affiliations

    • Departments of Obstetrics and Gynecology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
    • Akdeniz University School of Medicine, Antalya, Turkey
    • Corresponding Author InformationCorresponding author: Munire Erman Akar, MD, 131 Miller St., Comp Rehab, Center for Reproductive Medicine and Infertility, Winston-Salem, NC 27103.

Received 12 April 2010 ,Accepted 9 June 2010.

References 

  1. Goldner TE, Lawson HW, Xia Z, Atrash HK. Surveillance for ectopic pregnancy: United States, 1970–1989. MMWR Surveill Summ. 1993;42:73–85
  2. Chang J, Elam-Evans LD, Berg CJ, et al. Pregnancy related mortality surveillance: United States, 1991–1999. MMWR Surveill Summ. 2003;52:1–8
  3. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol. 2010;115:495–502
  4. Dialani V, Levine D. Ectopic pregnancy: a review. Ultrasound Q. 2004;20:105–117
  5. Stovall TG, Kellerman AL, Ling FW, Buster JE. Emergency department diagnosis of ectopic pregnancy. Ann Emerg Med. 1990;19:1098–1103
  6. Ankum WM, Mol BWJ, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65:1093–1099
  7. Dart RG, Kaplan B, Varaklis K. Predictive value of history and physical examination in patients with suspected ectopic pregnancy. Ann Emerg Med. 1999;33:283
  8. Kirk E, Condous G, Bourne T. Pregnancies of unknown location. Best Pract Res Clin Obstet Gynecol. 2009;23:493–499
  9. Barnhart KT, Katz I, Hummel A, Gracia CR. Presumed diagnosis of ectopic pregnancy. Obstet Gynecol. 2002;100:505–510
  10. Mertz H, Yalcinkaya T. Early diagnosis of ectopic pregnancy: does use of a strict algorithm decrease the incidence of tubal rupture. J Reprod Med. 2001;46:29–33
  11. Kadar N, Bohrer M, Kemmann E, Shelden R. The discriminatory human chorionic gonadotropin zone for endovaginal sonography: a prospective, randomized study. Fertil Steril. 1994;61:1016–1020
  12. Gracia CR, Barnhart KT. Diagnosing ectopic pregnancy: decision analysis comparing six strategies. Obstet Gynecol. 2001;97:464–470
  13. Condous G, Kirk E, Lu C, et al. There is no role for uterine curettage in the contemporary diagnostic workup of women with a pregnancy of unknown location. Hum Reprod. 2006;21:2706–2710
  14. Cacciatore B, Ylostalo P, Stenman UH, Widholm O. Suspected ectopic pregnancy: ultrasound findings and hCG levels assessed by an immunofluorometric assay. Br J Obstet Gynecol. 1988;95:497–502
  15. Shalev E, Yarom I, Bustan M, Weiner E, Ben-Shlomo I. Transvaginal sonography as the ultimate diagnostic tool for the management of ectopic pregnancy: experience with 840 cases. Fertil Steril. 1998;69:62–65
  16. Condous G, Okaro E, Khalid A, et al. The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod. 2005;20:1404–1409
  17. Pellerito JS, Taylor KJ, Quedens-Case C, et al. Ectopic pregnancy: evaluation with endovaginal color flow imaging. Radiology. 1992;183:407–411
  18. Bocciolone L, Vercellini P, Villa L, Rognoni MT, Dorta M, Fedele L. Early detection of ectopic pregnancy: use of a sensitive urine pregnancy test and transvaginal ultrasonography. J Reprod Med. 1991;36:496–499
  19. Romero R, Copel JA, Kadar N, Jeanty P, Decherney A, Hobbins JC. Value of culdocentesis in the diagnosis of ectopic pregnancy. Obstet Gynecol. 1985;65:519–522
  20. Cartwright PS, Vaughn B, Tuttle D. Culdocentesis and ectopic pregnancy. J Reprod Med. 1984;29:88–91
  21. Graczykowski JW, Seifer DB. Diagnosis of acute and persistent ectopic pregnancy. Clin Obstet Gynecol. 1999;42:9
  22. Braen GR, Pierce DL. Culdocentesis. In:  Roberts JR,  Hedges JR editor. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, PA: WB Saunders; 2009;p. 1063–1068
  23. Kirk E, Papageorghiou AT, Condous G, Tan L, Bora S, Bourne T. The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy. Hum Reprod. 2007;22:2824–2928
  24. Seeber BE, Barnhart KT. Suspected ectopic pregnancy. Obstet Gynecol. 2006;107:399–413
  25. Vermesh M, Graczykowski JW, Sauer MV. Reevaluation of the role of culdocentesis in the management of ectopic pregnancy. Am J Obstet Gynecol. 1990;162:411–413
  26. Herd AM, Sokal J. Case report: atypical ectopic pregnancy and culdocentesis; still a valuable emergency procedure. Can Fam Physician. 2001;47:2057–2061
  27. Segal S, Mercado R, Rivnay B. Ectopic pregnancy early diagnosis markers. Minerva Ginecol. 2010;62:49–62
  28. Word B. The diagnosis and treatment of ectopic pregnancy. Surg Gynecol Obstet. 1951;92:333–340
  29. Tenore JL. Ectopic pregnancy. Am Fam Physician. 2000;61:1080–1088
  30. Glezerman M, Press F, Carpman M. Culdocentesis is an obsolete diagnostic tool in suspected ectopic pregnancy. Arch Gynecol Obstet. 1992;252:5–9
  31. Stovall TG, Ling FW. Ectopic pregnancy: diagnostic and therapeutic algorithms minimizing surgical intervention. J Reprod Med. 1993;38:807–812
  32. Elliot M, Riccio J, Abbott J. Serous culdocentesis in ectopic pregnancy: a report of two cases caused by coexistant corpus luteum cycts. Ann Emerg Med. 1990;19:407–410
  33. Chen PC, Sickler GK, Dubinsky TJ, Maklad N, Jacobi RL, Weaver JE. Sonographic detedtion of echogenic fluid and correlation with culdocentesis in the evaluation of ectopic pregnancy. AJR. 1998;170:1299–1302
  34. American College of Obstetricians and Gynecologists. ACOG practice bulletin. Medical management of tubal pregnancy. Number 3, December 1998. Clinical management guidelines for obstetricians-gynecologists. Int J Gynaecol Obstet. 1999;65:97–103
  35. Carson SA, Buster JE. Ectopic pregnancy. N Engl J Med. 1993;329:1174–1181
  36. Pisarska MD, Carson SA, Buster JE. Ectopic pregnancy. Lancet. 1998;351:1115–1120
  37. Allahbadia GN. Fallopian tubes and ultrasonography: the Sion experience. Fertil Steril. 1992;58:901–907
  38. Wang Y, Zhao H, Teng Y, Lu L, Tong J. Human chorionic gonadotropin ratio of hemoperitoneum versus venous serum improves early diagnosis of ectopic pregnancy. Fertil Steril. 2010;93:702–705

 The authors have no commercial, proprietary, or financial interest in the products and companies described in this article.

PII: S1553-4650(10)00297-9

doi: 10.1016/j.jmig.2010.06.002

The Journal of Minimally Invasive Gynecology
Volume 17, Issue 6 , Pages 754-759 , November 2010

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