Adnexal Sonographic Findings in Ectopic Pregnancy and Their Correlation With Tubal Rupture and Human Chorionic Gonadotropin Levels

Frates, Mary C.; Doubilet, Peter M.; Peters, Hope E.; Benson, Carol B.

doi:10.7863/ultra.33.4.697

Cited by 44 publications

(39 citation statements)

References 18 publications

(39 reference statements)

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“…Berlingieri et al and Frates et al reported rates of ruptured normal ectopic pregnancy of 29.5% and 25.2%, respectively [30, 31], demonstrating that the rate of molar ectopic pregnancy rupture was significantly higher than that of normal ectopic pregnancy. This may be due to the higher invasive ability of trophoblasts in gestational trophoblastic disease compared with trophoblasts in normal pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Ectopic Molar Pregnancy: Diagnostic Efficacy of Magnetic Resonance Imaging and Review of the Literature

Yumura

Ohira

Yamazaki

et al. 2016

Case Reports in Obstetrics and Gynecology

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Ectopic molar pregnancy is extremely rare, and preoperative diagnosis is difficult. Our literature search found only one report of molar pregnancy diagnosed preoperatively. Moreover, there is no English literature depicting magnetic resonance image (MRI) findings of ectopic molar pregnancy. We report a case of ectopic molar pregnancy preoperatively diagnosed using MRI. A literature review of 31 cases of ectopic molar pregnancy demonstrated that lesions have been found in the fallopian tube (19 cases, 61%), ovary (5 cases, 16%), cornu (3 cases, 10%), peritoneum (2 cases, 6%), uterine cervix (1 case, 3%), and cesarean scar (1 case, 3%). Abdominal pain and abnormal vaginal bleeding were reported in 70% and 61% of the patients, respectively. Twenty-one cases (67%) presented with rupture and hemoperitoneum. All patients underwent surgical resection or dilatation and curettage. Methotrexate therapy was performed in one case because residual trophoblastic tissue was suspected. A second operation was performed in one case of ovarian molar pregnancy because serum hCG levels increased again after primary focal ovarian resection. No patients developed metastatic disease or relapsed. These findings suggest the prognosis of ectopic molar pregnancy to be favorable.

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Section: Discussionmentioning

confidence: 99%

“…Frates et al reported that the serum hCG levels of 225 normal ectopic pregnancy ranged within 7–107,949 mIU/mL [31]. Tasha et al reported 18 cases of ectopic gestational trophoblastic disease in 100 cases of ectopic pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Ectopic Molar Pregnancy: Diagnostic Efficacy of Magnetic Resonance Imaging and Review of the Literature

Yumura

Ohira

Yamazaki

et al. 2016

Case Reports in Obstetrics and Gynecology

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“…Pre-operative diagnosis of extra uterine molar pregnancy is difficult and exceptional [2] [10]. It is usually late especially in limited resource countries [11] and is frequently done at the stage of rupture [12] [13].…”

Section: Commentsmentioning

confidence: 99%

Bilateral Tubal Molar and Embryonic Pregnancy

Zamané¹,

Ouedraogo²,

Sawadogo³

et al. 2018

OJOG

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Aim: To report a case of bilateral tubal molar and embryonic pregnancy diagnosed and treated at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou, Burkina Faso. Observation: It was an 18-year-old patient, G2P0 with no known pathological history. She was received in obstetric emergencies for suspicion of ectopic pregnancy in a two-month amenorrhea context. At the admission, the physical examination had found a sensitivity of the hypogastric region with a cry of the umbilicus and the bleeding. At pelvic ultrasound, the uterus was empty with a medium-abundance pelvic effusion and a left extra uterine mass. The initial rate of beta HCG was 5700 ml IU per ml. A framed laparotomy was carried out. The operative exploration has revealed a right tubal pregnancy cracked and a left unbroken tubal pregnancy. The diagnosis of a bilateral ectopic pregnancy was retained. A right salpingectomy and a left tubal caesarean section were carried out. Histological analysis confirmed the diagnosis of a left embryonic ectopic pregnancy associated with a right molar ectopic pregnancy. Conclusion: The systematic use of histological analysis for any extra uterine pregnancy treatment is required to not ignore an associated molar pregnancy.

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“…While in the United States of America 9% of maternal mortality is attributed to EP. 10,11 The association between these different EP morphological types and management success has been examined in several studies. 2 The rates of EP are even higher in developing countries.…”

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confidence: 99%

“…In the 1970s, the diagnosis of EP was based upon non-visualisation of a gestational sac inside the uterus, utilising transabdominal scan at different cut-off values of serum human chorionic gonadotrophin (hCG). 10,11 The association between these different EP morphological types and management success has been examined in several studies. 6 The diagnosis of EP in modern practice is based upon the positive visualisation of an extrauterine mass on TVS 2,3 rather than the absence of an intrauterine gestational sac.…”

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confidence: 99%

Ultrasound features of tubal ectopic pregnancy

Nadim

Condous

2017

Australas J Ultrason Med

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D uring the last two decades, there have been tremendous advances in the recognition and management of ectopic pregnancies (EPs); nevertheless, EP remains a major cause of maternal morbidity and mortality. In westernised countries like the United Kingdom, the rate of EP is 11/ 1000 pregnancies with maternal mortality of 0.2/1000 (NICE guidelines 2012). While in the United States of America 9% of maternal mortality is attributed to EP. 1 In Australia, there were three maternal deaths between 2006 and 2010 (in comparison with two between 2000 and 2005) all of which were preventable. 2 The rates of EP are even higher in developing countries. 3 Importantly, we must also not underestimate the psychological trauma associated with EP and the impact on future fertility. 4 Early recognition and prompt referral are key factors to prevent catastrophic events such as tubal rupture and collapse. Early diagnosis allows the clinician to decide for more conservative approaches in EP management avoiding surgery and its associated risks of anaesthesia, blood loss and inadvertent injury to vascular and other pelvic structures at the time of laparoscopy.Ultrasound is the imaging method of choice to diagnose EP. In the 1970s, the diagnosis of EP was based upon non-visualisation of a gestational sac inside the uterus, utilising transabdominal scan at different cut-off values of serum human chorionic gonadotrophin (hCG). 5 ln the 1980s and 1990s, transvaginal ultrasound scan (TVS) was introduced and became widely used, resulting in earlier recognition of the EP mass at lower levels of quantitative hCG. 6 The diagnosis of EP in modern practice is based upon the positive visualisation of an extrauterine mass on TVS 2,3 rather than the absence of an intrauterine gestational sac. At the first presentation, TVS has a sensitivity of 73.9-74.7% in detecting EP, and the overall sensitivity of TVS in detecting EP in subsequent visits is 87-99% with specificity of 94-99%. 7,8 There are four distinct TVS morphologic criteria used to classify women with a tubal EP: (i) an inhomogeneous mass or 'blob' sign adjacent to the ovary and moving separately from the ovary; or (ii) a mass with a hyper-echoic ring around the gestational sac or 'bagel' sign; or (iii) a gestational sac with an embryonic pole with cardiac activity; or (iv) a gestational sac with an embryonic pole without cardiac activity. According to a consensus statement in 2011, 9 only the presence of a gestational sac with embryo (with or without cardiac activity) is considered to be a definite diagnosis of EP. According to the same consensus, the other two morphological ultrasound types 'blob' and 'bagel' signs are classified as probable EPs. The prevalence of these different morphological types in TVS has changed over the years. The most common morphological types are the 'blob' and 'bagel' signs accounting for almost 80% of all tubal EPs, whilst the presence of an embryo with or without cardiac activity accounts for 10-13%. 10,11 The association between these different EP morphologica...

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Adnexal Sonographic Findings in Ectopic Pregnancy and Their Correlation With Tubal Rupture and Human Chorionic Gonadotropin Levels

Abstract: Transvaginal sonography showed an adnexal abnormality in nearly 95% of our patients with ectopic pregnancy, most commonly a nonspecific adnexal mass. Embryonic cardiac activity was seen in fewer than 10%. Neither sonographic findings nor hCG levels were useful predictors of tubal rupture.

Cited by 44 publications

References 18 publications

Ectopic Molar Pregnancy: Diagnostic Efficacy of Magnetic Resonance Imaging and Review of the Literature

Ectopic Molar Pregnancy: Diagnostic Efficacy of Magnetic Resonance Imaging and Review of the Literature

Bilateral Tubal Molar and Embryonic Pregnancy

Ultrasound features of tubal ectopic pregnancy

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