Ultrasound in Contraception, Infertility, and Ectopic Pregnancy

Flashcards reviewing the use of ultrasound in contraception, infertility and ectopic pregnancy, based on lecture notes.

What is the only contraception method where ultrasound is useful?

Intrauterine Contraceptive Device (IUD)

what is a foreign material placed in the uterine cavity to prevent pregnancy?

IUD

What is the purpose of an IUD?

To prevent implantation in the uterus of a fertilized ovum.

Name two types of IUDs.

Paragard T380A (Copper T) and Progestasert

how does the IUD prevent pregnancy?

create a hostile endometrial environment of a fertilzed ovum/cervical mucous, too thick to allow sperm to penetrate cx/ut

does not prevent fertilization from occurring but it prevents what from happeining?

implantation of the fertilized ovum in the uterus

Where should an IUD be positioned in the uterus?

In the fundus, above the internal os.

Describe the ultrasound appearance of an IUD.

High amplitude echoes, centrally located in the uterus, with acoustic shadowing and entrance/exit echoes.

What can ultrasound be used for in relation to a 'lost' IUD?

To localize it.

what are some risks of an IUD?

PID, ectopic pregnancy, concurrent pregnancy and IUD, ut perforation

List some pitfalls of imaging in IUD localization.

Difficult to see in retroverted uterus, fibroids can displace the uterine cavity, IUDs may not be visible on US in the secretory phase of menstrual cycle.

Failure to conceive after at least one year of trying?

infertility

How is ultrasound used in infertility?

Diagnosis of disease/structural defects, with hormonal stimulation for ovulation induction, as a guide for retrieval/placement of ova in 'in vitro' fertilization.

Give some common female infertility factors

Age, infection (PID), surgery, disease, congenital anomalies, hormonal imbalance

Name two parameters to predict follicular development during ovulation induction therapy

Basal body temperature, Cervical mucous and Estrogen levels

What are some side effects of ovulation induction therapy?

Increased risk of multiple pregnancy, Ovarian Hyperstimulation Syndrome (OHSS)

What are the two methods of retrieval for In-vitro fertilization?

Laparoscopy and US guided retrieval

What is GIFT?

Gamete Intrafallopian Transfer - sperm and ova are placed in the fallopian tube.

Define ectopic pregnancy.

Implantation of a fertilized ovum outside the endometrial cavity.

What is a key statistic about ectopic pregnancies?

Leading cause of maternal death in the first trimester.

Where do most ectopic pregnancies occur?

Fallopian tubes (95% of the time).

List common causes of ectopic pregnancy.

Mechanical obstruction in fallopian tube, history of previous ectopic, PID, tubal ligation, IUD use, endometriosis, congenital abnormalities, assisted reproductive techniques

What is the clinical triad of ectopic pregnancy symptoms?

Vaginal bleeding, adnexal mass, and pelvic pain.

Describe some ultrasound findings suggestive of ectopic pregnancy.

Uterus without a gestational sac, pseudogestational sac, complex adnexal mass, fluid in the posterior cul de sac, fluid in Morrison’s pouch, decidual reaction.

List other procedures used to detect ectopic pregnancies.

D & C (Dilation and Curettage), Culdocentesis, Laparoscopy

What are the different treatment options for ectopic pregnancy?

Methotrexate (up to 6 weeks), Surgery (Laparotomy, salpingectomy, salpingostomy), Hysterectomy/wedge resection (interstitial), Surgical (abdominal)

Define heterotopic pregnancy.

A pregnancy with both an ectopic and intrauterine component.

What is the primary purpose of an ultrasound protocol for ectopic pregnancy?

Identification of IUP (sac with decidual reaction or fetal pole)