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Abstract

Background: Ectopic pregnancy is a leading cause of maternal morbidity and mortality in early gestation, necessitating timely and accurate diagnosis to avert adverse outcomes. Ultrasonography, particularly transvaginal sonography, has emerged as a pivotal diagnostic tool due to its non-invasive nature and accessibility. Despite its widespread use, variability in diagnostic precision, especially specificity, remains a concern, highlighting the need for continuous evaluation against definitive surgical findings to enhance clinical decision-making and reduce unnecessary interventions.
Objective: To determine the diagnostic accuracy of ultrasound in diagnosing ectopic pregnancy, using surgical findings as the gold standard.
Methods: This descriptive cross-sectional study was conducted at the Jinnah Postgraduate Medical Centre (JPMC), Karachi. Women aged 18–40 years presenting with clinical suspicion of ectopic pregnancy, based on signs, symptoms, and β-hCG levels above 5 IU/L, were enrolled using non-probability consecutive sampling. Transvaginal ultrasound examinations were performed by experienced radiologists, and findings were compared with surgical outcomes. Data were analyzed using SPSS version 26.0. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated along with 95% confidence intervals.
Results: A total of 240 participants were included, with a mean age of 29.29 ± 5.84 years; 60% were aged 18–30 years, while 40% were above 30 years. Ultrasound accurately identified 220 cases of ectopic pregnancy. Sensitivity was 97.77% (95.85%–99.70%), specificity was 60.0% (35.21%–84.79%), PPV was 97.35%, and NPV was 64.29%. The overall diagnostic accuracy was 95.42%. Positive and negative likelihood ratios were 2.44 and 0.04, respectively.
Conclusion: Ultrasound demonstrated high sensitivity and diagnostic accuracy in detecting ectopic pregnancy when compared to surgical findings. Despite moderate specificity, ultrasound remains a vital, non-invasive tool for early diagnosis, although additional confirmatory strategies may be required to minimize false positives and optimize patient management.