Ectopic pregnancy: duplex Doppler evaluation

Of 398 patients in whom there was a clinical suspicion of ectopic pregnancy, 96 (24%) were found to have the condition. Of the 96, 70 underwent duplex Doppler imaging. A viable ectopic fetus was seen in 10 of 70 (14%), and an extrauterine sac without an identifiable fetus was seen in an additional 27, giving a sensitivity for imaging alone of 53%. Fetal heart activity was detected with Doppler in 13 (19%). High-velocity flow, which suggested the presence of an ectopic pregnancy, was detected in 38 of 70 (54%) patients (total preoperative sensitivity, 73%). In the 91 patients who did not have an ectopic pregnancy, duplex Doppler imaging of the intrauterine contents alone allowed an ectopic pregnancy to be excluded in 29 (32%) on the first examination and in a further 21 on the second scan (specificity, 55%). Nine vascular adnexal masses were falsely considered to be ectopic pregnancies (specificity, 90%). The positive predictive values were 47% for imaging alone and 85% for Doppler. The negative predictive values were 60% for imaging alone and 81% for Doppler.     

Ectopic pregnancy: a pictorial review

Ultrasound has remained the primary modality for investigating the pelvis of women in the reproductive age group, especially in an emergency setting. Recognition of different sonographic presentations, including typical and atypical findings of ectopic pregnancy, is important to determine surgical or nonsurgical management. This pictorial review article will exemplify different sonographic presentations of ectopic pregnancy.     

Ectopic pregnancy in uncommon implantation sites

The majority of ectopic pregnancies are located within the fallopian tube. Nevertheless, pregnancies have been reported to implant in the cervix, ovary, interstitial tubal segment, and at various intra-abdominal sites. The diagnosis and treatment of these unusual implantation sites presents a challenge for clinical as well as radiological diagnosis and there is a tendency to overlook its possibility. In this study, we attempt to summarize the current data regarding diagnosis and optimal treatment of these unusual ectopic pregnancies from our experience with six unusual types of ectopic pregnancies from the Women Hospital, Doha, Qatar.     

Ectopic pregnancy: a malpractice paradigm

Subtle sonographic findings and other nonspecific clinical presentations often lead to missed diagnoses that can have significant legal implications. This communication discusses current diagnostic and laboratory methods used to evaluate patients with a suspected ectopic pregnancy in light of the concepts of "missed lesions" as they relate to negligence and malpractice theory.     

Ectopic pregnancy: surgical-pathologic correlation with US

The ultrasound (US) examinations of 53 patients with proved ectopic pregnancy were reviewed and compared with surgical and pathologic findings. The most common finding with US and surgery was free fluid. Hematosalpinx tended to have sharply defined margins, whereas free pelvic hematomas were poorly defined or filled the pelvis. The echogenicity of the clots was variable but generally in the same range of echogenicity as the uterus. A prominent decidual reaction occurred in 26% of the patients and had a variety of appearances.     

Ectopic pregnancy: features at transvaginal sonography.

A retrospective review of the transvaginal sonograms of 50 women with laparoscopically confirmed ectopic pregnancy was performed to determine whether certain sonographic findings can be detected to confirm the diagnosis. Forty-seven of the 50 pregnancies were tubal. A tubal ring (a 1-3-cm mass consisting of a 2-4-mm concentric, echogenic rim of tissue surrounding a hypoechoic center) was seen in 23 of 34 (68%) ectopic pregnancies in which the fallopian tube had not ruptured, and the tubal ring could be distinguished from a corpus luteum cyst in most cases. Transvaginal sonography also depicted simple (n = 22) or particulate (bloody) (n = 13) peritoneal fluid associated with ectopic pregnancy. In each case in the series, at least one abnormal uterine, adnexal, or peritoneal finding was detected at transvaginal sonography. Because of its improved resolution of uterine and adnexal structures, transvaginal sonography is recommended as a means for detailed evaluation of patients suspected of having an ectopic pregnancy.     

Ectopic pregnancy: criteria and accuracy of ultrasonic diagnosis.

Of 26 ectopic pregnancies, a correct positive ultrasonic diagnosis was made in 77%, while a false negative diagnosis was made in 23%. Most commonly, the ectopic pregnancy appeared as a complex adnexal mass immediately adjacent to an enlarged "empty" uterus. Ultrasonic identification of an extrauterine gestational sac, allowing a definitive diagnosis of ectopic pregnancy, was uncommon.     

Ectopic pregnancy: evolution after treatment with transvaginal methotrexate.

A prospective study was performed with 25 patients with ectopic pregnancies (EPs) who underwent treatment with transvaginal administration of methotrexate. Nineteen patients (76%) had positive responses to this treatment, and six (24%) had to undergo surgery: five because of increasing abdominal pain and one because of vaginal bleeding. The ultrasonographic (US) resolution of the EP was long and lagged behind the resolution at testing of levels of beta subunit of human chorionic gonadotropin (beta-hCG) in all patients. The fallopian tube in 12 (63%) of the responding group initially increased in diameter from a mean of 2.22 cm to a mean of 3.84 cm. In 13 (68%) of the responding group, it became more vascular at color Doppler examination. Eleven (92%) of the 12 EPs that increased in size also became more vascular. The increase in tubal size and vascularity, in spite of the falling beta-hCG level, represents a healing process and should cause no concern about the follow-up of these patients.     

Ectopic pregnancy: evaluation with endovaginal color flow imaging.

Endovaginal sonography and endovaginal color flow imaging were compared in 155 patients with clinical suspicion of ectopic pregnancy. Sixty-five patients (42%) had surgically confirmed ectopic pregnancies. Thirty-six of the pregnancies were diagnosed with endovaginal sonography alone, the criteria being an extrauterine sac or ectopic fetus (sensitivity, 54%). Sixty-two ectopic pregnancies were diagnosed with endovaginal color flow imaging (sensitivity, 95%) when an ectopic fetus or sac was seen or placental flow was identified in an adnexal mass separate from the ovary and uterus. The diagnosis of ectopic pregnancy was excluded with endovaginal sonography (specificity, 98%) and endovaginal color flow imaging (specificity, 98%) by finding an intrauterine gestation, nonvisualization of an adnexal mass, and absence of placental flow. Three false-positive and three false-negative diagnoses were made with endovaginal color flow imaging (positive predictive value, 97%). The addition of color Doppler flow imaging to endovaginal sonography allows increased sensitivity in the detection of ectopic pregnancy.     

Ectopic pregnancy: Value of transabdominal sonography without deliberate bladder distention

We reviewed 19 consecutive patients with ectopic pregnancy in whom pelvic sonography demonstrated findings highly predictive of the diagnosis. The correct diagnosis was established by transabdominal sonography without attempting bladder distention in 12 patients (63%); the bladder was full in only one patient. Transabdominal sonography performed without waiting for the bladder to fill and thus with no delay or patient discomfort can establish the presence of ectopic pregnancy and obviate the need for transvaginal sonography in a substantial proportion of patients in whom the diagnosis can be made sonographically. In patients at risk for ectopic pregnancy, we recommend that transabdominal sonography without waiting for bladder distention be attempted before transvaginal sonography is performed.     

Ectopic pregnancy within a rudimentary horn in a case of unicornuate uterus

We report the MRI features of two cases of unicornuate uterus and occluded rudimentary horn. In one patient pregnancy had occurred in the occluded horn, prompting to urgent resection. The second patient illustrates more conventional findings in occluded rudimentary horn. In both cases MRI was able to correctly characterise the nature of the developmental anomaly. Furthermore, on the basis of signal intensities, differentiation between distended lumen due to blood accumulation and amniotic sac in the case of pregnancy could be made. Because of its high accuracy in determining the type of anomaly present, the lack of ionizing radiation, and the ability to evaluate, with the exception of the fallopian tubes, the entire genitourinary tract, MR imaging is essential and plays a key role in the evaluation of women who are consulting for infertility.     

急诊腹腔镜联合自体血液回收机救治休克型异位妊娠

目的:研究急诊腹腔镜手术联合自体血液回收机救治休克型异位妊娠的安全性和有效性。方法:采用回顾性队列研究的方法,对我院2008-01～2011-12间急诊腹腔镜或开腹手术联合自体血液回收机救治休克型异位妊娠患者的一般资料、手术效果、术后恢复情况及术中术后并发症进行比较。其中腹腔镜手术32例,开腹手术24例。结果:①腹腔镜组自体血回输速度快(22.3±4.0)min vs(40.9±4.5)min、异体输血率低(11.8%vs 38.5%)、术后体温恢复快(3.3±0.9)d vs(4.8±1.3)d、住院天数短(4.7±1.1)d vs 5.8±1.2)d,与开腹组比较具有显著差异(P<0.05);②两组自体血回输量、术后血红蛋白、术后最高体温及住院费用之间无显著差异,两组术中术后均无严重并发症。结论:急诊腹腔镜联合自体血液回收机可快速有效回输自体血,显著减少异体输血,使腹腔镜手术治疗休克型异位妊娠更为安全有效。     

Ectopic pregnancy: a resident’s guide to imaging findings and diagnostic pitfalls

Emergency Radiology - Ectopic pregnancy (EP) is a term used to describe any pregnancy which does not implant into the uterine cavity. There are several types of EPs: tubal, interstitial, ovarian,...     

Ectopic renal artery

A case of aberrant origin of the right renal artery from the aorta at level Th 12, above the origin of the visceral arteries is reported. The literature of these rare anomalies of the origin of the renal arteries is reviewed.