Color Flow Doppler Guides Ectopic Management.

MAUI, HAWAII -- Transvaginal ultrasound can be helpful not only in diagnosing ectopic pregnancy but in guiding management of the disorder, Dr. Bill Yee said at a conference on ob.gyn. ultrasound sponsored by the University of California, Irvine.

Color flow Doppler ultrasound helps assess the extent of blood flow to the ectopic mass. An ectopic pregnancy with normal vasculature might be managed medically with methotrexate or managed surgically with salpingotomy, said Dr. Yee of the university and director of the in vitro fertilization program at Long Beach (Calif.) Memorial Medical Center.

For an ectopic pregnancy that has a good deal of neovasculature, however, Dr. Yee recommended surgical intervention rather than methotrexate, because the mass could rupture during the several days it takes for the drug to have an effect.

Dr. Yee also tells such patients that removing the mass may cause heavy bleeding and that, although he will try to repair the tube, it may be necessary to remove it.

"We're going to go directly to a salpingectomy rather than spend a couple of hours trying to control the bleeding," because such extensive efforts to control bleeding end up destroying the tube anyway, he said.

Ultrasound management of ectopic pregnancy is a new concept that any medical center with color flow Doppler ultrasound should be able to accommodate.

Office-based clinicians--most of whom do not have the sophisticated ultrasound equipment themselves--should consider referring patients for a color flow Doppler scan once an ectopic pregnancy has been diagnosed, Dr. Yee noted during the meeting, which was also sponsored by the medical center.