Small Ruminant Research 105 (2012) 277281

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Small Ruminant Research

journal homepage: www.elsevier.com/locate/smallrumres

Short communication

The accuracy of transvaginal ultrasonography for early pregnancy

diagnosis in Saanen goats: A pilot study
A. Koker a , D. Ince b , M. Sezik c,
a
b
c

Mehmet Akif Ersoy University, Faculty of Veterinary Medicine, Department of Obstetrics and Gynecology, Burdur, Turkey
Suleyman Demirel University, Faculty of Agriculture, Department of Animal Science, Isparta, Turkey
Suleyman Demirel University, Faculty of Medicine, Department of Obstetrics and Gynecology, Isparta, Turkey

a r t i c l e

i n f o

Article history:
Received 16 August 2011
Received in revised form 10 February 2012
Accepted 20 February 2012
Available online 13 March 2012
Keywords:
Accuracy
Goat
Live birth
Pregnancy diagnosis
Transvaginal ultrasonography

a b s t r a c t
Data on the use of transvaginal ultrasonography for pregnancy diagnosis in goats are scarce.
The transabdominal and transrectal routes have been repeatedly investigated. The aim of
this study was to evaluate the accuracy of real-time transvaginal ultrasound for early pregnancy diagnosis in 50 multiparous Saanen dairy goats. Following estrous synchronization
and mating, a B-mode real-time scanner with a 57.5 MHz multi-frequency endocavitary
probe was used to examine the animals, in a standing position. The value of visualizing at
least one gestational sac (with or without any fetal pole) to predict the birth of at least one
live kid was monitored at 38 weeks post mating. The accuracy (proportion of true positives and true negatives to the overall study population) for predicting a live birth increased
gradually from 65% at week 3, to 93% at week 8 post mating. Sensitivity values followed a
similar pattern (61% at week 3, increasing to 100% at week 8). Positive and negative predictions at week 8 were 90% and 100%, respectively. However, the relationship between
the observed number of fetal sacs and the actual number of live births was only 17% at
week 3, increasing to about 60% at week 8. In conclusion, transvaginal ultrasound during
early pregnancy in Saanen goats (especially 56 weeks post mating) can effectively predict live births, but not multiple pregnancies. Further investigations comparing the use of
transrectal and transvaginal routes in pregnant goats should be encouraged.
2012 Elsevier B.V. All rights reserved.

1. Introduction
Transabdominal scanning of pregnant goats has been
shown to be effective and reliable under eld conditions
(Hesselink and Taverne, 1994). More recent investigations
have revealed transrectally performed ultrasonography to
diagnose early pregnancy in goats, to be rapid and more
accurate (Gordon, 2004). However, fecal repletion and rectal brittleness are potential drawbacks (Aria et al., 2004).
There is also an increased theoretical risk of infection and

Corresponding author at: Suleyman Demirel University, Faculty

of Medicine, Department of Obstetrics and Gynecology, 32260 Isparta,
Turkey. Tel.: +90 246 2119239; fax: +90 246 2120383.
E-mail address: msezik@yahoo.com (M. Sezik).
0921-4488/$ see front matter 2012 Elsevier B.V. All rights reserved.
doi:10.1016/j.smallrumres.2012.02.013

luminal wall injury or bleeding using the rectal probe, compared to the vaginal probe. Moreover, the sensitivity of
transrectal scans may decrease in the absence of fasting
of the animal overnight (Karen et al., 2009).
The widespread use of transvaginal sonography in the
evaluation of early human pregnancy has provided routine
visualization of the uterine contents in medical obstetrics and gynecology (Goldstein and Timor-Tritsch, 2007).
Transvaginal ultrasound has also been utilized in baboons
and humans for early assessment of the implantation
site and conrmation of gestational age of pregnancy
(Santolaya-Forgas et al., 1997). Despite routine use in
humans, the transvaginal route has seldom been studied
during gestation in animals, especially small ruminants
(Aria et al., 2004; Moraes et al., 2007).

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A. Koker et al. / Small Ruminant Research 105 (2012) 277281

Therefore, the aim in the present preliminary study was

to assess the applicability and reliability of transvaginal
ultrasonography in Saanen goats during early pregnancy.
It was hypothesized that this underestimated technique in
animal science could provide a reliable prediction for the
subsequent delivery of healthy kids.

2. Materials and methods

Fifty Saanen multiparous dairy goats (age ranging from 3 to 6 years;
mean body weight, 38 1 kg) were used for this study. Animals were
identied from the herd of the Sleyman Demirel University Sheep-Goat
Research Farm and maintained in a semi-open pen, at the universitys
research farm, and reared on natural pasture. The predominant forage
species in the natural pasture was Quercus coccifera. Does were allowed to
graze on the natural pasture from 05:30 to 11:30 and from 16:30 to 21:30,
and kept in pens overnight. Water and a mineral salt lick were provided
ad libitum. All animals were under similar environmental, nutritional, and
management conditions throughout the experimental period.
The estrous cycle of the goats was synchronized with the aid of
intravaginal progestogen sponges, impregnated with 20 mg uorogestone
acetate (FGA, Chrono-gest , Intervet Productions SA, Igoville, France). On
day 10 of treatment, animals were injected with 0.75 mg (0.5 mL) Tiaprost
i.m. (Iliren , Intervet International B.V., Boxmeer, The Netherlands).
Sponges were removed after 12 days, and all females received an i.m.
injection of 500 IU PMSG (Folligon , Intervet International B.V., Boxmeer,
The Netherlands). Two days after withdrawal, does were mated (10 does:1
buck). The bucks had undergone a previous breeding soundness examination and remained in the herd for 4 days. Therefore, it was possible
to determine the day of breeding, with a 2 day variation. Following
synchronization, all goats exhibited estrus.
For ultrasonogphy a B-mode real-time scanner (Aquila Pro, Esaote,
Maastricht, The Netherlands) was used, attached to an annular array sector of 57.5 MHz, multi-frequency, transvaginal probe (Esaote, Maastricht,
The Netherlands). All the ultrasound procedures were performed by one of
the researchers. Transvaginal examinations were performed with the animal in the normal standing position, restrained on an examination table.
The probe was lubricated with conventional ultrasound gel, protected
with a disposable sheath and cleaned with a chlorhexidine solution prior
to each examination. The probe was gently introduced into the vagina
rst at a 45 of upward angle, and then forward, straight cranially. The
entire pelvis was visualized with 90 rotations. If visualization was suboptimal, the operator lifted the abdominal wall of the animal gently with the
non-dominant hand. The 7.5 MHz frequency was preferred. Ultrasound
examinations were repeated at intervals of 7 days, between weeks 3 and
8 post mating. For data reliability, all diagnostic information was recorded
by an alternate researcher apart from the ultrasound operator so that the
operator was ignorant to all the previous diagnostic data to prevent being
bias. A pilot eld trial that included transvaginal ultrasound examinations
of 40 pregnant goats had been performed prior to the current research.
During transvaginal ultrasound scanning, the uterus was visualized,
using the urinary bladder as reference, that was located slightly craniodorsally. In non-pregnant does, the uterus appeared as a spherical structure
with a linear transverse echogenic density (Medan et al., 2004). Alternatively, a gestational sac was dened as a circular or an elongated anechoic
structure 2 mm in diameter within the uterine cavity, cranial to the
bladder. Pregnancy was considered whenever any gestational sac and/or
embryo was visualized. Multiple pregnancies (twins or triplets) were considered when >1 amniotic cavity and/or embryonic body was recognized.
The early pregnancy diagnosis using ultrasound (weeks 38) and
the birth data were recorded onto a Microsoft Excel (version 12)
spreadsheet. The variables recorded were the presence/absence and
number of gestational sac(s) and/or embryo(s) at the corresponding
ultrasound examination and live births at term. The similarity between
the sonographically observed embryos and the actual number of live
births was determined. Sensitivity, specicity, positive predictive value
(PPV), negative predictive value (NPV), positive likelihood ratio (LR(+)),
negative likelihood ratio (LR()), and accuracy values for the prediction
of subsequent live birth were calculated for each examination week,
using 2 2 contingency tables (Drobatz, 2009), with the SPSS version
13.0 (Chicago, IL) software. The chi-square test was used to compare percentages. For all statistical analyses, P < 0.05 differences were considered

Table 1
Reproductive properties of the study goat population (50 does) following
estrous synchronization.
n
Does in estrus
Infertility
Abortion
Kidding rate
Singleton at birth
Twin at birth
Triplet at birth
Litter size
Fecundity

50
5
2
43
19
19
5

% or mean
100
10.0
0.5
86
44.2
46.3
12.2
1.78
1.46

to be signicant. The accuracy of ultrasonographic diagnosis for single

and multiple pregnancies was also determined.

3. Results
No complications attributable to the scanning technique
were noted. The overall pregnancy rate was 90%, and 56%
(23/46) of the ongoing pregnancies (at delivery) were multiples. No physical abnormalities in the does and kids were
observed. There were no identied vaginal infections. Further reproductive properties of the study are summarized
in Table 1. The kidding rate and the litter size were 86% and
1.78, respectively. About 60% of the births being multiples
(Table 1).
Table 2 demonstrates the change in sensitivity, specicity, positive and negative predictive values, false positive
and negative rates, positive and negative likelihood ratios,
and overall accuracy values over time, for the prediction
of live births. The detection rate (sensitivity) tended to
increase post mating from weeks 3 to 8, ultimately reaching 100% at week 8. The specicity i.e. the proportion
of correctly identied non-pregnancies ending without
a delivery at term, was generally high, except week 4
(Table 2). The PPV (positive predicted value) followed a
similar pattern, with almost no differences for the initial
(week 3) and nal (week 8) ultrasound scans. However, the
NPV (negative predictive value) followed a similar pattern
regarding the sensitivity estimates, increasing gradually
from initially 20% to 100% at week 8. Hence, the proportion of pregnancies with a negative test (no pregnancy)
that were correctly diagnosed (no term delivery) was quite
low, until week 7. This was reected by relatively high false
negative predictions until week 7. The likelihood ratio for
a positive result (term live birth) was constantly above 5
(except week 4), indicating that transvaginal ultrasound is
generally a good screening test for predicting live births
especially after week 4 post-mating. On the other hand, the
likelihood ratio for a negative test result declined rather
sharply after week 5 and was below 0.2 only after week
6. That would point to a satisfactory prediction of the
likelihood of a true negative result (no live birth) only at
weeks 7 and 8. The overall accuracy values seem to conrm
these data and increased progressively from 65% to reach
a plateau of approximately 93% at weeks 7 and 8 (Table 2).
In Table 3 the reliability of transvaginal ultrasonography for predicting multiple births at the various weeks of
examination is set out. The determination of gestational
sacs and/or embryos using transvaginal scans seemed to

A. Koker et al. / Small Ruminant Research 105 (2012) 277281

279

Table 2
Diagnostic and screening performance of transvaginal ultrasound for the predication of term live birth in 50 does examined weekly from weeks 3 to 8, post
mating.

Sensitivity (%)
Specicity (%)
PPV (%)
NPV (%)
FPR (%)
FNR (%)
LR(+)
LR()
Accuracy (%)

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

61.3
100
100
20.0
0
38.7

0.38
64.7

72.7
42.8
85.7
25.0
57.2
27.3
1.28
0.63
67.5

65
100
100
65
0
35.0

0.35
70.1

84.3
100
100
55
0
15.7

0.16
86.8

92.3
100
100
75.0
0
7.7

0.07
93.7

100
83.3
90
100
17
0
5.8
0
93.3

PPV, positive predictive value; NPV, negative predictive value; FPR, false-positive rate; FNR, false-negative rate; LR(+), positive likelihood ratio; LR(),
negative likelihood ratio; accuracy, the proportion of true results (sum of true positives and true negatives) in the whole population.

underestimate the number of subsequent kids delivered at

term. Although this underestimation bias decreased with
advancing gestation, it remained relatively high (45%),
even at week 8. None of the triplet births (n = 5) were
predicted at any of the examinations. Unexpectedly, the
overall similarity was signicantly higher at week 7, compared to week 8 (58% vs. 46%, P < 0.05). This was probably
due to the increased overestimation bias at week 8, leading to decreased (55%) conrmation of singletons, despite
higher (83%) predictions for twin births (Table 3).

4. Discussion
In this study, an early transvaginal scan at 3 weeks
of gestation had a relatively low detection rate (60%)
for term births. However, there were no false positives at
this stage. Visualization of a gestational sac and/or embryo
at the initial scan was constantly associated with an ongoing pregnancy, although these constituted only about
two thirds of the pregnancies that continued until term.
This gure seems similar to previous results obtained with
transabdominal scanning. So for instance, the accuracy of
the transabdominal route was found to be 52% on days
1719 in the ewe (Garcia et al., 1993). On the other hand,
transrectal ultrasound generally yielded earlier detection
success rates. Amer (2010) conrmed that pregnancy could
be recognized 45 days earlier than with an abdominal
probe. In an investigation including cyclic Shiba goats,
the accuracy of transrectal ultrasonography for pregnancy
diagnosis was found to be 100% at a mean gestation of
24.3 0.7 days (Medan et al., 2004). Others also reported
comparable ndings, revealing the earlier detection of the
gestational sac with transrectal ultrasound in pregnant
goats (Gonzalez-Bulnes et al., 1998; Martinez et al., 1998;

Singh et al., 2004; Padilla-Rivas et al., 2005; Suguna et al.,

2008).
Such data on early diagnosis of pregnancy with transrectal ultrasound may, however, be biased due to the
lower accuracy at these early stages. Most of these previous
studies recognized the subsequent diagnosis of pregnancy,
but not the term live birth, as the outcome variable.
Therefore, the high incidence of embryonic losses during
early pregnancy was not considered. Likewise, in a recent
comprehensive review (Gonzalez-Bulnes et al., 2010) it
was encouraged to wait for days 32 to 34 for the efciency of ultrasonography in detecting pregnancy to reach
85100%, depending on the operator experience. Deterioration of certain parameters through week 4 of gestation
were possibly secondary to early miscarriages in this study
population.
During week 4 post mating in the current study, the
transvaginal ultrasonography detected nearly 75% of pregnancies destined to end with live term birth. However, the
specicity and PPV were lower at week 4, compared to
scanning earlier. A thorough analysis revealed that all the
false positives at this point were negative at the following scans. Furthermore in 75% of the false positives, only
the gestational sac, without a visible sac was detected (data
not shown). Those could indicate that most of the false positives at 4 weeks of gestation were indeed pregnancies with
restricted growth, destined to end in spontaneous abortion.
This was not surprising, as most of the detectable pregnancy failures occurred at this stage (Rattner et al., 1994).
Therefore, it may be speculated that the relative low LR(+)
and NPV at week 4 may be associated with early pregnancy losses. A potential limitation of the current study
layout should be mentioned at this point. Only live births at
term were considered as the outcome variable. Therefore,
no data on early pregnancy losses or intrauterine deaths

Table 3
Consistency between the number of gestational sacs and/or embryos detected on transvaginal ultrasound and subsequent term live births.

Overall similarity (%)

Overall differences (%)
Underestimate (%)
Overestimate (%)
Similarity for singletons (%)
Similarity for twins (%)
Similarity for triplets (%)

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

17
83
76
7
33
0
0

37
63
60
3
44
42
0

38
62
58
4
27
50
0

42
58
52
6
46
54
0

58
42
38
4
80
50
0

46
54
46
8
55
83
0

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A. Koker et al. / Small Ruminant Research 105 (2012) 277281

were available. This gure seemed more rational to use, as

the prediction potential of transvaginal ultrasound would
account mostly for the live kids at birth.
With the elimination of false positives at week 4, the
specicity and PPV was excessive at week 5 of scan, despite
the low detection rate. However, the accuracy at 5 weeks
of gestation reached 70%, which could make transvaginal
ultrasound a viable option for the detection of an on-going
pregnancy at this stage. At 6 weeks of gestation, similar
to scanning at week 5, there were no false positives. Furthermore, the detection rate had increased substantially
to about 85%. A problem at this stage was the low predictive capacity of transvaginal ultrasound. Data indicate that
a positive pregnancy regarding transvaginal ultrasound
at this point strongly indicates subsequent birth at term.
Nonetheless, a negative nding (no sac or embryo) is not
very reliable, as almost half of those negatives were indeed
continuing pregnancies.
Despite improvements in various parameters at week
5 of pregnancy, the accuracy for live births to term was
approximately 70% lower than the expected value for the
routine transrectal route (Martinez et al., 1998). This could
be due to low experience in the use of the vaginal probe in
goats, or inadequacy of transvaginal scanning at this stage
of pregnancy.
A mathematical problem was encountered with division
by 0 when evaluating the LR (likelihood ratio). Therefore,
some of the LR(+) values were not available (Table 2).
The LR(+) and LR() values can provide better estimates
regarding the diagnostic potential of a clinical test, as the
screening tool. A LR(+) greater than 6 and LR() below
0.2 generally indicates superior potential in the test used
for screening (Elavunkal and Sinert, 2009). Current data
showed that these criteria for the likelihood ratios were
reached marginally at week 6 and absolutely at week 7.
Moreover, the sensitivity and overall accuracy was also
quite high and approaching 90% at week 7 of scanning.
Although the sensitivity was outstanding at 8 weeks, the
false positive rate was about 20%, decreasing the LR(+)
and specicity. This was probably due to increasing uterine size at this gestational week. Therefore, false may be
a concern with the uterus growing out of the pelvic cavity and creating technical difculties for the transvaginal
route.
Transvaginal ultrasound was relatively underperforming in the goat population for predicting multiple
births. Parallel results have been reported with the transrectal probe. A recent investigation on 110 dairy goats,
recorded an overall accuracy of 54% for detecting twins
and triplets using the rectal probe (Amer, 2010). Technical difculties with prenatal ultrasound to differentiate
between twins and triplets or quadruplets at any stage
of pregnancy in the goat and sheep have generally been
encountered (Goel and Agrawal, 1992; Amer, 2008, 2010).
In contrast, few other investigations have reported a
higher efcacy in counting the number of conceptuses
in multiple pregnancies reaching 100% at 7 week of
gestation (Dawson et al., 1994; Medan et al., 2004). At
this point, there is not enough data to determine whether
using the rectal or vaginal techniques, allows for better
prediction of multiple births in goat pregnancies.

Only a single publication in English on transvaginal

sonography of small ruminants was found (Aria et al.,
2004). This preliminary study included 48 Massese sheep
and only 3 goats. The consistency between concurrent
transabdominal and transvaginal scans were 90% and
91% for positive and negative results, respectively. The
researchers (Aria et al., 2004) concluded that transvaginal ultrasound scanning could represent an early, easy, and
alternative method to the actually more complicated transabdominal method. Transvaginal ultrasound thus seemed
more hygienic and safer than the transrectal technique. The
current data considerably expands on the previous preliminary information of Aria et al. (2004), with a larger
and more homogenous group, performing weekly examinations from week 3 of gestation to week 8.
A limitation of the present study was the lack of evidence of the convenience of the transvaginal technique,
compared to the transrectal method. Another point that
could be lacking is that of a non-mated control group,
making the calculations for the diagnostic result nonpregnancy relatively inadequate. It is obvious that the
calculated PPV and NPV was calculated from a group, with
a representative number from both possible diagnostic
outcomes. The researcher responsible for the ultrasonography had considerable experience with transabdominal and
transrectal ultrasound, but not with the transvaginal route.
For this reason, a pilot eld trial that included transvaginal
ultrasound examinations of 40 pregnant goats was performed prior to the current research. Hence, it could be
unlikely that the current results were inuenced, as the
experience of the operator increased with progress of the
study. Despite such shortcomings, these preliminary data
are novel in this research area, and warrant future investigation.
In summary, this data indicated that the optimal timing for a reliable transvaginal ultrasound scan in pregnant
goats to be at week 7 post mating, when the diagnostic and
screening parameters seem to be most accurate. However,
earlier scans may provide a relatively good positive prediction for live birth at term and can be clinically functional, as
well. Further investigations comparing the utility of transrectal and transvaginal routes in pregnant goats should
therefore be encouraged.

Acknowledgment
The abstract was presented as a poster at the 15th
Annual Conference of European Society for Domestic
Animal Reproduction, 1517 September 2011, Antalya,
Turkey.

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