{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T04:28:29Z","timestamp":1785558509372,"version":"3.56.0"},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,4,22]],"date-time":"2013-04-22T00:00:00Z","timestamp":1366588800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the value of transvaginal sonography (<jats:styled-content style=\"fixed-case\">TVS<\/jats:styled-content>) in the diagnosis of heterotopic pregnancy (<jats:styled-content style=\"fixed-case\">HP<\/jats:styled-content>) in the first trimester after <jats:italic>in\u2010vitro<\/jats:italic> fertilization with embryo transfer (<jats:styled-content style=\"fixed-case\">IVF\u2010ET<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective review of women undergoing <jats:styled-content style=\"fixed-case\">IVF<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">ET<\/jats:styled-content> between January 2005 and December 2011. Women were diagnosed with an <jats:styled-content style=\"fixed-case\">HP<\/jats:styled-content> using <jats:styled-content style=\"fixed-case\">TVS<\/jats:styled-content> if a visible intrauterine gestational sac was observed with any of the following: (i) an inhomogeneous adnexal mass; (ii) an empty extrauterine gestational sac seen as a hyperechoic ring; or (iii) a yolk sac and\/or fetal pole with or without cardiac activity in an extrauterine sac.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 16\u2009483 consecutive women who underwent <jats:styled-content style=\"fixed-case\">IVF<\/jats:styled-content> had <jats:styled-content style=\"fixed-case\">TVS<\/jats:styled-content> during the study. Of these, 174 cases were diagnosed on <jats:styled-content style=\"fixed-case\">TVS<\/jats:styled-content> as having an <jats:styled-content style=\"fixed-case\">HP<\/jats:styled-content>, and 10 cases were missed. Fifty\u2010two cases were treated expectantly and were excluded from the analysis. Three types of ultrasonographic presentation of ectopic pregnancy (<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content>) were seen in <jats:styled-content style=\"fixed-case\">HP<\/jats:styled-content> patients, with a gestational sac found in 70 cases, a ring sign in 21 and an adnexal mass in 31. The sensitivity and specificity of <jats:styled-content style=\"fixed-case\">TVS<\/jats:styled-content> for the detection of <jats:styled-content style=\"fixed-case\">HP<\/jats:styled-content> were 92.4 and 100%, respectively, with positive and negative predictive values of 100 and 99.9%. The <jats:styled-content style=\"fixed-case\">HP<\/jats:styled-content> cases comprised 103 tubal <jats:styled-content style=\"fixed-case\">EPs<\/jats:styled-content> and 29 non\u2010tubal <jats:styled-content style=\"fixed-case\">EPs<\/jats:styled-content>. In 93 patients (70.5%), their intrauterine pregnancy resulted in a live birth, 37 patients (28.0%) suffered an early miscarriage and two patients (1.5%) had a late miscarriage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Early <jats:styled-content style=\"fixed-case\">TVS<\/jats:styled-content> performed by an experienced sonographer has a high sensitivity for making the correct diagnosis of <jats:styled-content style=\"fixed-case\">HP<\/jats:styled-content> after <jats:styled-content style=\"fixed-case\">IVF\u2010ET<\/jats:styled-content>. Copyright \u00a9 2012 ISUOG. 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