Unusual Ectopic Pregnancies

Ectopic pregnancy is a considerable source of morbidity and mortality for women of childbearing age. Improved detection and increased risk factors have led to a dramatic rise in the incidence of ectopic pregnancy in recent years. Early diagnosis is critical for the health of the patient as well as the success rate of future pregnancies. Besides laparoscopy, sonography is the mainstay for evaluating ectopic pregnancy. It is important to understand the sonographic features of ectopic pregnancies, including unusual cases that occur outside the fallopian tube.     

Sonographic diagnosis of uncomplicated first-trimester pregnancy in the rudimentary horn of a unicornuate uterus

Although pregnancy in a rudimentary uterine horn is rare, the correct diagnosis of this condition on routine sonographic examination is critical, because its natural history usually involves the rupture of the pregnant horn during the second or third trimester, resulting in life-threatening bleeding. We report a case in which the diagnosis of right unicornuate uterus with a left noncommunicating rudimentary horn was made in the first trimester on routine sonographic examination.     

The unicornuate uterus and its variants: clinical presentation, imaging findings, and associated complications

This article will describe the different variants of the unicornuate uterus, their clinical presentation and imaging findings, as well their associated complications. We will also review the associated renal anomalies. Patients' symptoms and their imaging findings will vary depending on the unicornuate subtype. Radiologic evaluation includes a combination of hysterosalpingography, sonography, and magnetic resonance imaging. Complications include obstetric ones related to the small uterine size and endometriosis and ectopic pregnancies when a cavitary rudimentary uterine horn is present. Radiologists should be familiar with all variants of the unicornuate uterus as well as their clinical presentation and associated imaging findings.     

Rudimentary horn pregnancy: first-trimester prerupture sonographic diagnosis and confirmation by magnetic resonance imaging.

OBJECTIVE: Two cases of rudimentary horn pregnancy diagnosed in the first trimester by sonography and confirmed by magnetic resonance imaging (MRI) are reported. We suggest criteria for early, prerupture sonographic diagnosis of this rare condition. METHODS: We report a case in which pregnancy in a rudimentary horn was suspected on routine sonographic examination. In the second case, sonographic examination at 11 weeks' gestation revealed a right unicornuate uterus and a noncommunicating left rudimentary horn containing a gestational sac. In both cases, MRI clearly confirmed the sonographic diagnosis, showing an empty cavity of the uterine body and a pregnant uterine horn without an endometrial communication to the uterine body. RESULTS: Both patients underwent surgery, and the pregnant rudimentary horns were resected with no complications. CONCLUSIONS: We suggest the following criteria for sonographic diagnosis of rudimentary horn pregnancy: (1) a pseudopattern of a asymmetrical bicornuate uterus, (2) absent visual continuity tissue surrounding the gestational sac and the uterine cervix, and (3) the presence of myometrial tissue surrounding the gestational sac. Typical hypervascularization of placenta accreta may support the diagnosis. Additionally, MRI can be used to confirm the diagnosis before an invasive procedure is undertaken.     

甲氨蝶呤治疗异位妊娠150例疗效分析

【目的】观察甲氨蝶呤(MTX)肌肉注射治疗异位妊娠疗效及安全性。并探讨其应用适应证和监测指标。【方法】肌肉注射甲氨蝶呤20mg／d。连续5d为一疗程,观察患者自觉症状和一般情况进行血β-HCG水平监测和B超检查直至正常。【结果】150例中145例成功(包括2例重复注射)成功率96．67％。【结论】严密观察下,血β-HCG水平及动态变化．B超盆腔积液包块大小,可作为重复注射和剖腹探查指标．处理腹痛患者要慎重。     

超声在异位妊娠诊断中的临床价值

目的：探讨超声在异位妊娠中的诊断及鉴别诊断价值。方法：回顾性分析我院超声诊断45例异位妊娠,并与手术及病理检查结果进行对照。结果：经超声诊断异位妊娠正确率达88.9%（40/45）。结论：超声对异位妊娠的诊断和鉴别诊断均具有较好的临床价值。     

Emergency Department Right Upper Quadrant Ultrasound Is Associated with a Reduced Time to Diagnosis and Treatment of Ruptured Ectopic Pregnancies

OBJECTIVE: To determine whether the time to diagnosis and treatment of patients with ruptured ectopic pregnancy is significantly less for patients who had emergency department (ED) right upper quadrant (RUQ) ultrasound (US) compared with those who had US in the radiology department. METHODS: The authors conducted a retrospective review of eligible patients presenting to an urban ED between January 1990 and December 1998. Patients were included in the study if they were seen in the ED, had a discharge diagnosis of ruptured ectopic pregnancy, were brought immediately to the operating room after a definitive diagnosis of ectopic pregnancy rupture was made, and had more than 400 mL of intraperitoneal blood found at the time of surgery. The ED, hospital, radiology, and operative records were reviewed to determine presenting vital signs, intraperitoneal blood loss, time to diagnosis, time to treatment, and type of US performed. RESULTS: There were 37 patients enrolled; 16 received ED RUQ US (group I) and 21 had a formal US in radiology (group II). The ages, pulses, systolic blood pressures, and volumes of hemoperitoneum were similar between the two groups. The average time to diagnosis from ED arrival was 58 minutes for group I (SD = 57; 95% CI = 28 to 87) and 197 minutes for group II (SD = 82; 95% CI = 162 to 232) (p < or = 0.0001). The average time to operative treatment was 111 minutes (group I) (SD = 86; 95% CI = 69 to 153) and 322 minutes (group II) (SD = 107; 95% CI = 270 to 364) (p < or = 0.0001), respectively. CONCLUSIONS: Patients with ruptured ectopic pregnancy, who were selected to have RUQ US performed in the ED by emergency physicians, had an average decrease in time to diagnosis of two and a quarter hours, and an average decrease in time to treatment of three and a half hours, compared with those having a formal pelvic US in the radiology department. Further prospective investigation is needed to determine whether ED RUQ US can safely expedite care of patients with suspected ectopic pregnancy.     

经阴道超声检查对早期宫外孕的诊断价值

目的 探讨应用经阴道超声检查对早期宫外孕的诊断价值。方法对临床疑诊为宫外孕但经腹部超声检查不明确的186例患者进行经阴道超声检查，记录宫外孕肿块超声图像、彩色血流特点及彩色血流阻力指数。结果经阴道超声诊断结合血液HCG检查结果诊断早期宫外孕179例，漏诊7例，超声诊断符合率96．2％。结论经阴道超声检查，对早期宫外孕的诊断具有重要的价值，为诊断早期宫外孕的首选方法。     

Diagnosis and laparoscopic management of a rudimentary horn pregnancy: Role of three‐dimensional ultrasound

Rudimentary horn pregnancy occurs in 1 in 76,000–150,000 pregnancies and causes uterine rupture in about 80% of cases. The use of three‐dimensional transvaginal ultrasound seems to be useful for its early detection. We present a case of an 8‐week pregnancy in a rudimentary horn, managed by laparoscopic excision. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45 :112–115, 2017;     

非典型性宫外孕声像图及彩色多普勒表现分析

目的分析探讨非典型性官外孕声像图及彩色多普勒表现，减少漏诊和误诊。方法48例非典型性官外孕患，全部经阴道超声检查。检查结果与临床诊断对照。结果48例非典型性官外孕，诊断准确率98．1％。其异位类型为：输卵管妊娠和卵巢妊娠。结论对本类病例当超声探及腹腔少量积液、附件区包块、卵巢内蜕膜样反应、官内假孕囊、探头加压触痛敏感时，应高度提示官外孕。超声提示病灶部位对治疗方案的选择有参考价值。     

阴道B超与腹部B超诊断异位妊娠的临床价值

目的:比较阴道B超与腹部B超在异位妊娠诊断中的临床应用价值。方法:将2012年6月-2013年6月收治的74例疑似异位妊娠患者随机分为观察组与对照组各37例,分别给予阴道B超和腹部B超检查,比较两组的诊断准确率。结果:观察组患者的诊断符合率为91.89%(34/37),明显高于对照组的81.08%(30/37)(P0.05);观察组显示孕囊或包块的时间与选择手术时间明显优于对照组(P0.05)。结论:与应用腹部B超相比较,应用阴道B超诊断的异位妊娠诊断符合率更高,且显示孕囊或包块的时间与患者选择手术时间更短。     

Point-of-Care Ultrasound Diagnosis of Cesarean Scar Ectopic Pregnancy: A Case Series

BackgroundA cesarean scar pregnancy (CSP) is a clinically important form of ectopic pregnancy that carries a high risk of maternal morbidity and mortality. As the rate of cesarean sections has risen, this diagnosis is becoming an increasingly important consideration for providers caring for patients in early pregnancy.Case ReportWe present three cases of CSPs in which point-of-care ultrasound expedited the diagnosis and treatment in the emergency department.Why Should an Emergency Physician Be Aware of This?Given the risks of an undiagnosed CSP, the increasing incidence of CSP, and the number of effective treatment options available in early gestation, the prompt and accurate diagnosis of CSP remains crucial to its successful management. As such, it is an important diagnosis for the emergency physician to consider when evaluating a patient in early pregnancy.     

二维超声及彩超诊断未破型宫外孕

目的　探讨未破型宫外孕的超声诊断方法。方法　选择１６ 例经二维超声与彩色多普勒血流显像首诊,临床确诊的未破型宫外孕病例,对其超声检查资料进行分析。结果　全部病例均显示附件包块。１２ 例（７５ ％ ） 显示肿块内相对周围组织增多的彩色血流信号。频谱多普勒表现附件肿块内低阻血流频谱。ＲＩ值０４２ ±０．０８,子宫动脉及卵巢血流无特征性变化。结论　附件区肿块,肿块内相对周围组织增多的彩色血流信号是超声诊断未破型宫外孕的关键。输卵管妊娠的病理生理改变与超声图像表现相关。疑为宫外孕时,耐心细致地寻找附件包块至关重要。     

First trimester screening aids in the diagnosis and management of an ectopic pregnancy in a noncommunicating uterine horn

Pregnancy within a noncommunicating rudimentary horn has a 70% chance of rupturing, with a maternal mortality of 0.5%. It is most commonly managed with operative removal of the horn. We report a pregnancy within a noncommunicating horn and highlight the advantage of early diagnosis via sonography. First trimester prenatal screening via sonographic examination allows early diagnosis of müllerian duct abnormalities and ectopic pregnancy. This information expedites management of such pregnancies, thus decreasing maternal morbidity and increasing the chance of future fertility.     

腹部超声联合阴道超声应用于异位妊娠的早期诊断价值

【目的】探讨腹部超声联合阴道超声应用在异位妊娠早期诊断中的临床价值。【方法】对450例尿妊娠试验阳性、血HCG超标、临床及最后手术病理结果确诊为异位妊娠的患者随机分成腹部超声（TAS）联合阴道超声（TVS）检查组232例（试验组,A组）和单一应用TAS或TVS检查组218例（对照组,B组）,统计两组附件区包块、卵黄囊、胎芽、原始心管搏动、宫内假孕囊的检出率。【结果】A组阳性229例,漏诊3例,临床诊断符合率为98．7％;B组阳性191例,漏诊27例,临床诊断符合率为87．6％。经χ^2检验,两组间临床符合率比较,差异有统计学意义（P〈0．05）。【结论】TAS联合TVS的应用能及时、准确诊断异位妊娠,提高诊断率,为指导临床及时治疗及选择治疗方法具有重要意义。     

经阴道超声结合腹部加压法对异位妊娠的诊断

目的：探讨经阴道超声结合腹部加压法诊断异位妊娠的价值。方法回顾性分析以异位妊娠收入住院的157例患者的经阴道超声声像图特征,并与临床最终诊断结果相对照。结果157例患者中临床最后诊断为异位妊娠156例（包括宫内妊娠并异位妊娠1例）,宫内妊娠1例;经阴道超声结合腹部加压法检出异位妊娠154例,漏诊异位妊娠2例,检出宫内妊娠1例,检出异位妊娠敏感性为98.72%（154/156）、准确性为98.73%（155/157）。结论经阴道超声能够为临床诊断异位妊娠提供可靠的线索。