Virtual Sonographic Hysterosalpingoscopy for Ectopic Pregnancy Detection

Objective: To describe a novel noninvasive diagnostic technique, named virtual sonographic hysterosalpingoscopy, which can be helpful for the detection of ectopic tubal pregnancy. Materials & Methods: Sonographic hysterosalpingoscopy was performed with the use of fly-through technology in 10 pregnant women in whom ectopic pregnancy was suspected. All examinations were performed by a vaginal ultrasound probe, without entering physically either the uterus or the fallopian tube. The resulting 2-dimensional recordings were subsequently transformed to 3-dimensional virtual endoscopy images. Results: Ectopic tubal pregnancy was confirmed in 3 cases. Dilated proximal tubal ostia could be virtually entered in all of them, and embryonic structures were identified in one case. In the remaining 7 cases ectopic tubal pregnancy was excluded and an intrauterine gestational sac was found. In 4 of these cases the sac was abnormal and the pregnancy was eventually lost. In 3 cases the sac was normal, the pregnancy went on and endometrial polyps were identified as the probable source of bleeding.The diagnosis was later confirmed by conventional methods in all cases. Conclusion: Virtual sonographic hysterosalpingoscopy is a rapid and highly precise method with which the source of uterine bleeding can be tracked along the cavities of the uterus and the fallopian tubes in search for tubal ectopic pregnancy. The use of the fly-through sonographic technique can be extended to the examination of other fluid-filled body cavities.