BRITAIN: ROUTINE ULTRASOUND QUESTIONED – Utility of a routine ultrasound for detection of ectopic pregnancies amongst women requesting abortion: a retrospective review

by Clara I Duncan, John J Reynolds-Wright, Sharon T Cameron

BMJ SRH Journal 2021;12 January:1-2  DOI: 10.1136/bmjsrh-2020-bsacp.2

This abstract was published as part of a group of five abstracts for the Online Webinar Conference Jointly Organised by the British Society of Abortion Care Providers and the Royal Society of Medicine’s Sexuality & Sexual Health Section, held on 12 October 2020.

Background – Routine ultrasound may be used in abortion services to determine gestational age and confirm an intrauterine pregnancy. However, women may present before there is definitive evidence of an intrauterine pregnancy and the utility of routine ultrasound in excluding ectopic pregnancy is unclear. We sought to determine the rate of ectopic pregnancy and the utility of routine ultrasound in their detection, in a community abortion service.

Methods – Retrospective case record review of women requesting abortion over 5 years (2015–2019) at a service conducting routine ultrasound (Edinburgh, UK), with an outcome of ectopic pregnancy or pregnancy of unknown location (PUL). Records were searched for symptoms at presentation, development of symptoms during clinical care, significant risk factors and routine ultrasound findings.

Results – 29 out of 11 381 women (0.25%, 95% CI 0.18%– 0.33%) had an outcome of ectopic pregnancy or PUL (tubal=18, caesarean scar=1, heterotopic=1, PUL=9). 11 (38%) cases had either symptoms at presentation (n=8) and/or significant risk factors for ectopic (n=4). A further 12 women developed symptoms during their clinical care. Of the remaining 6, 3 were PUL treated with methotrexate and 3 were ectopic (salpingectomy=2, methotrexate=1). However, in 2 of these 6 cases, ultrasound falsely indicated an intrauterine pregnancy.

Conclusions – Ectopic pregnancies are uncommon amongst women presenting for abortion. The value of routine ultrasound in excluding ectopic pregnancy in symptom-free women without significant risk factors is questionable as it may aid detection of some cases but may give false reassurance that a pregnancy is intrauterine.