Diagnostic Clues to Ectopic Pregnancy

Abstract

Ectopic pregnancy accounts for approximately 2% of all pregnancies and is the most common cause of pregnancy-related mortality in the first trimester. Initial evaluation consists of hormonal assays and pelvic ultrasonography (US). A history of pelvic pain along with an abnormal beta human chorionic gonadotropin level should trigger an evaluation for an ectopic pregnancy. The fallopian tube is the most common location for an ectopic pregnancy. An adnexal mass that is separate from the ovary and the tubal ring sign are the most common findings of a tubal pregnancy. Other types of ectopic pregnancy include interstitial, cornual, ovarian, cervical, scar, intraabdominal, and heterotopic pregnancy. Interstitial pregnancy occurs when the gestational sac implants in the myometrial segment of the fallopian tube. Cornual pregnancy refers to the implantation of a blastocyst within the cornua of a bicornuate or septate uterus. An ovarian pregnancy occurs when an ovum is fertilized and is retained within the ovary. Cervical pregnancy results from an implantation within the endocervical canal. In a scar pregnancy, implantation takes place within the scar of a prior cesarean section. In an intraabdominal pregnancy, implantation occurs within the intraperitoneal cavity. Heterotopic pregnancy occurs when an intrauterine and an extrauterine pregnancy occur simultaneously. A spectrum of intra- and extrauterine findings may be seen on US images. Although many of the US findings are nonspecific by themselves, when several of them are seen, the specificity of US in depicting an ectopic pregnancy substantially improves.

Study on Risk Factors, Clinical Presentation & Operative Management of Ectopic Pregnancy

“…Ultrasound examination of pelvic organs is widely used to evaluate clinically stable patient suspected of having ectopic pregnancy 22 . In this study 76% patients were diagnosed by ultrasonogram.…”

Recurrent Interstitial pregnancy: a new approach in diagnosis with MRI and management with systemic methotrexate along with intra foetal cardiac 10% potassium chloride

“…3 Ultrasonography is remains the principal modality for diagnosis of interstitial pregnancy. 4 Timor-Tritsch et al (1992) for the sonographic diagnosis of interstitial pregnancy suggested to see an "empty uterus with a gestational sac that is seen separately and <1 cm from the most lateral edge of the uterine cavity and a thin myometrial layer surrounding the sac". 5 Tanaka Y et al (2014) emphasized the importance of three-dimensional ultrasonography (3D TVS), 6 with its capacity to reproduce the coronal plane of the uterus and assist the exact localization of the gestational sac relative to the uterine cornu.…”

Akut Abdomen

“…Olguların çoğunluğunda yerleşim yeri fallop tüpleridir, tüplerde ise en sık ampuller bölgede meydana gelir. Bunun dışında interstisyel/kornual, ovaryen, servikal, sezaryen skarı ya da abdominal yerleşimli ektopik gebelik de görülebilir [19]. Belirteç olarak serum β-hCG ve progesteron düzeylerinin normal gebeliklere göre daha yavaş artması kullanılır.…”

“…Belirteç olarak serum β-hCG ve progesteron düzeylerinin normal gebeliklere göre daha yavaş artması kullanılır. Görüntüleme öncesi β-hCG düzeyle-rinin bilinmesi önemlidir, çünkü 2000 IU'dan küçük değerlerde normal gebeliklerin US'de görülmesi beklenmez [19,20].…”