Comparative study of transabdominal ultrasound alone versus combined transabdominal and transvaginal ultrasound in gynecological acute abdomen.

BACKGROUND: Gynecological acute abdomen is a common emergency condition requiring rapid and accurate diagnostic imaging to guide timely clinical decision-making. This study evaluated the diagnostic value of transabdominal ultrasound (TA-US), transvaginal ultrasound (TV-US), and their combination in patients with suspected gynecological acute abdomen. METHODS: This single-center retrospective study analyzed 120 patients with suspected gynecological acute abdomen, divided into three groups (n=40 each) based on the ultrasound examination received: TA-US, TV-US, and combined ultrasound. Detection rates for different types of gynecological acute abdomen were compared, along with diagnostic accuracy, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV). Kappa test was used to evaluate consistency with comprehensive clinical diagnoses. RESULTS: Comprehensive clinical diagnosis identified 65 cases of ectopic pregnancy and 39 cases of corpus luteum rupture. Combined TA-US and TV-US achieved the highest detection rates for ectopic pregnancy (100.00%) and corpus luteum rupture (93.33%), outperforming TA-US (69.57%, 75.00%) and TV-US (77.27%, 83.33%) alone (P<0.05). Overall detection rates for TA-US, TV-US, and combined were 70.00%, 77.50%, and 95.00%, respectively, with combined being the highest (P<0.05). The kappa coefficients for combined, TA-US, and TV-US were 0.771, 0.186, and 0.343, indicating good consistency between combined examination and clinical diagnosis (P<0.05). Combined examination achieved accuracy (95.00%), sensitivity (97.14%), specificity (80.00%), PPV (97.14%), and NPV (80.00%). Its accuracy and sensitivity were significantly superior to TA-US (70.00%, 71.43%) and TV-US (77.50%, 79.41%), and its NPV was also higher than TA-US (all P<0.05). CONCLUSIONS: TA-US and TV-US each have diagnostic value for gynecological acute abdomen, but their combined use improves accuracy and sensitivity, providing a more reliable clinical assessment.