Unit 6- Ectopic Pregnancy

What is an ectopic pregnancy?

• Any pregnancy outside the uterus

Where is the most common site of an ectopic pregnancy?

Ampulla of fallopian tube

Ectopic pregnancies make up what percent of maternal deaths?

10%

When is an ectopic pregnancy have an increased incidence?

• Tubal surgery

• STI (STD),

• PID,

• IUD,

• Elective AB,

• Infertility treatments,

• Hx of previous ectopic pregnancy

  • 1-2 % of all pregnancies in the US

What is the definition of prevalence?

The number of people who currently have the condition (=Ectopic pregnancies at any given time.)

What is the definition of Incidence?

The annual number of people who have a new case of the condition (70,000 USA)

What are the clinical signs of an ectopic pregnancy?

• Pain

• Vaginal bleeding

• Palpable adnexal mass

• Hypovolemic shock

• Amenorrhea

• Shoulder/neck pain

• Positive quantitative pregnancy test increasing at an abnormal rate (normal doubling every 2.3 days)

When can a pregnancy be identified TV?

4.5 weeks

What are the Beta HCG levels of an ectopic pregnancy?

• hCG is measured in milli-international units per milliliter (mIU/ml).

• TV =1000 mIU/ml (2^nd IS)

  • (Second International Standard)*

• TA = 6500 mIU/ml(IRP)

  • (International Reference Preparation)

• Beta hCG will rise then plateau in ectopic pregnancy

What is the criteria for an ectopic pregnancy?

• Positive hCG > 1000mIU/ml

• No IUGS – thickened endometrium

  • (decidual reaction)

• Extrauterine mass

• Fluid in cul-de-sac

• Extrauterine GS with heartbeat

What are these images showing?

Ectopic pregnancy

What are these images showing?

Ectopic pregnancy

What are these images showing?

Ectopic pregnancy

What are these images showing?

Ectopic pregnancy

What are the sonographic signs of an ectopic pregnancy?

• Adnexal mass

• Empty uterus which may have a thick endometrium

• Free fluid in pelvis and upper peritoneum

• Absence of double- walled gestational sac

• Pseudogestational sac -Empty sac located in endometrium

• Fetus in abnormal position

• Pain with pressure of the vaginal probe

What are the pitfalls of an ectopic pregnancy?

• Ruptured bleeding corpus luteum

• Unilateral discomfort may mimic ectopic pain

• Rare occurrence of IUG & Ectopic PG

  • Increased incidence with ART

What occurs in a pseudogestational sac?

• No double sac sign

• Blood in endometrial cavity

What is this image showing?

Pseudogestational Sac

What should always be imaged to rule out ectopic?

Adnexa

What are possible findings when scanning the adnexa for an ectopic pregnancy?

• Complex ovarian mass

• Thickened echogenic ring

• Possible yolk sac or embryo

• Lower quadrant pain

• Free fluid

• Positive pregnancy test

What is this images showing?

Ectopic pregnancy

When imaging an ectopic preganacy, you should use CDI for what type of flow?

Peritrophoblastic flow

What is the bagel sign?

Separated ectopic from ovarian mass

What are these images showing?

Ectopic pregnancy

What can be found in an ectopic pregnancy with an adnexal mass?

• Complex adnexal mass

• Free fluid in cul de sac

  • Anechoic

  • Hypoechoic

  • Echogenic

What are these images showing?

Adnexal mass with ectopic pregnancy

What is a heterotopic pregnancy?

• Intrauterine and extrauterine pregnancy

• Uncommon

What are these images showing?

Heterotopic Pregnancy

What is an interstitial pregnancy?

• Ectopic pregnancy at the interstitial or cornual

• At segment fallopian tubes enters uterus

What is the most life threatening ectopic pregnancy when ruptures?

Interstitial Pregnancy

Interstitial pregnancy is _________ to identify on US

Difficult

What are these images showing?

Interstitial Pregnancy

What is Cervical Pregnancy?

• Demonstration of gestational sac within the cervix

• Spontaneous AB – may have similar appearance

What is this image showing?

Cervical Pregnancy

Ovarian Pregnancy can be very ______ and difficult to _________.

Rare; diagnose