Chapter 19: Sonographic Assessment of the Ectopic Pregnancy Flashcards
1
Q
gestation located in the intraperitoneal cavity, apart from tubal, ovarian, or intraligamentous sites
A
abdominal pregnancy
2
Q
A number of techniques used to aid fertilization, including in vitro fertilization, intracytoplasmic sperm insertion, follicle aspiration, sperm injection, and assisted follicular rupture
A
assisted reproductive techniques
3
Q
glycoprotein hormone produced in pregnancy made by developing embryo soon after conception and later by the placenta
A
beta-hCG
4
Q
gestation located within the endocervical canal
A
cervical pregnancy
5
Q
gestation located within a rudimentary uterine horn or one horn of a bicornuate or septated uterus or a gestation located within a rudimentary horn of a uterus with a mullerian anomaly
A
cornual pregnancy
6
Q
level of beta-hCG at which a normal intrauterine pregnancy can be seen with sonography
A
Discriminatory cutoff
7
Q
two concentric hyperechoic rings (representing the echogenic base of the endometrium and the decidua capsularis/chorion laeve) surrounding the anechoic gestational sac in a normal IUP
A
double decidual sac sign
8
Q
implantation of a fertilized ovum in any area outside of the endometrial cavity
A
ectopic pregnancy
9
Q
concomitant intrauterine pregnancy and ectopic pregnancy
A
heterotopic pregnancy
10
Q
life-threatening condition due to a decrease in blood volume
A
hypovolemic shock
11
Q
gestation located in the intramyometrial segment of the fallopian tube
A
interstitial pregnancy
12
Q
gestation located within the myometrium of the uterus
A
intramural pregnancy
13
Q
form on birth control; small, plastic or copper, usually T-shaped device with a string attached to the end that is inserted into the uterus
A
intrauterine contraceptive device (IUD)
14
Q
Laboratory procedure in which sperm are placed with an unfertilized egg in a petri dish to achieve fertilization; the embryo is then transferred into the uterus to begin a pregnancy or cryopreserved for future use
A
in vitro fertilization
15
Q
hepatorenal recess; deep recess of the peritoneal cavity on the right side extending upward between the liver and the kidney; gravity dependent portion of the peritoneal cavity when in supine position
A
Morison pouch
16
Q
Gestation located within the ovary
A
ovarian pregnancy
17
Q
infection of the female reproductive tract resulting from microorganisms transmitted especially during sexual intercourse, or by other means such as during surgery, abortion, or parturition
A
PID
18
Q
pregnancy in which no signs of an intrauterine pregnancy or ectopic pregnancy are seen on sonography
A
pregnancy of unknown location (PULS)
19
Q
when gentle pressure from the transducer moves he gestational sac
A
sliding sac sign
20
Q
hyperechoic ring of trophoblastic tissue that surrounds an extrauterine gestational sac
A
tubal ring sign
21
Q
Ectopic pregnancy accounts for ___ of all pregnancies in the US.
A
2%
22
Q
Leading cause of maternal death in the first trimester
A
ectopic pregnancy
23
Q
Where is the fallopian tube derived from?
A
Mullerian duct system
24
Q
Only connection between peritoneal and endometrial cavity
A
fallopian tube
25
Key risk factors to ectopic pregnancy
history of ectopic pregnancy
prior tubal surgical procedures
PID
26
History of PID increases the risk of ectopic _____.
sevenfold
27
Key findings of ectopic pregnancy
vaginal bleeding
pelvic pain
palpable adnexal mass
28
When is an ectopic pregnancy typically diagnosed?
6-10 weeks
29
Beta-hCG plateaus at ____ weeks.
9-11
30
In a normal IUP, the beta hCG should ____ every 48 hours.
double
31
level of beta-hCG at which a normal IUP can be seen with ultrasound
discriminatory cutof
32
discriminatory cutoff endovaginal
above 1,500 to 2,500 mIU/mL
33
Differential diagnosis is discriminatory cutoff below and IUP not visualized
early normal IUP
spontaneous abortion
ectopic pregnancy
34
implants within uterine cavity above level or internal os, medial to interstitial portion of fallopian tubes, eccentrically within uterine cavity
normal intrauterine gestation
35
How often is an ectopic implanted in the fallopian tubes?
95%
36
What part of fallopian tube does an ectopic usually occur?
ampullary
37
What three segments of fallopian tube can you find a tubal ectopic?
ampullary, isthmus, fimbria
38
occurs in intramyometrial segment of fallopian tube
interstitial pregnancy
39
Interstitial pregnancies account for ___ of all ectopics.
2-4%
40
How late can an interstitial pregnancy go on without symptoms?
16 weeks
41
increased risks for interstitial pregnancy
prior ipsilateral salpingectomy
IVF
42
occurs within a rudimentary uterine horn or one horn of a bicornuate or septate uterus
Cornual pregnancy
43
Why is a cornual pregnancy classified as ectopic?
propensity to rupture in the second trimester
44
Cornual pregnancy accounts for ______ of all ectopics/
less than 1%
45
five different locations of pregnancy that occur in cornual region of uterus
interstitial
rudimentary horn of unicornuate uterus
horn of bicornuate uterus
horn of septate uterus
angular pregnancie
46
located eccentrically within endometrial cavity near uterotubal junction
angular pregnancies
47
occurs when gestation implants within the endocervical canal
cervical pregnancy
48
Cervical pregnancy accounts for _____ of ectopic pregnancies
less than 1%
49
increased risk factors for cervical pregnancy
previous currettage
anatomic anomalies
endometriosis
IUD use
50
occurs by implantation of the gestation within the myometrium of the uterus
intramural pregnancy
51
Intramural pregnancy accounts for _____ of all ectopic pregnancies.
less than 1%
52
occurs when fertilized ovum implants in ovary
ovarian pregnancy
53
Ovarian pregnancy accounts for ____ of all ectopic pregnancies.
1-3%
54
occurs when ovum implants within intraperitoneal cavity, aside from tubal, ovarian, or intraligamentous sites
abdominal pregnancy
55
Abdominal pregnancy accounts for ____ of all ectopic pregnancies.
up to 1.4%
56
occurs when fertilized ovum implants within intraperitoneal cavity
primary abdominal pregnancy
57
occurs when a tubal ectopic pregnancy ruptures or aborts and reimplants within intraperitoneal cavity
secondary abdominal pregnancy
58
occurs when two or more fertilized ova implant
heterotopic pregnacy
59
Most frequent symptom of heterotopic pregnancy
abdominal pain
60
pelvic mass in patients with low or absent beta-hcG levels and minimal symptoms
chronic ectopic pregnancy
61
What is the discriminatory cutoff from transabdominal sonography?
more than 6500 mIU/mL
62
On an endovaginal scan, the gestational sac with a double decidual sac sign can be seen at ___ weeks.
4.5-5
63
On an endovaginal scan, the yolk sac can be seen at ___ weeks.
5
64
On an endovaginal scan, the fetal pole with cardiac motion can be seen at _____ weeks.
5.5-6
65
inconclusive transvaginal sonogram with declining beta-hCG levels to undetectable levels without an IUP or ectopic gestation identification
trophoblast in regression
66
hepatorenal recess
Morison's pouch
67
The endometrial stripe thickness should be less than __ mm
8
68
fluid collection caused by bleeding from decidualized endometriam
pseudosac
69
The ______ abuts the endometrial canal.
gestational sac
70
eccentrically located gestational sac surrounded by very thin layer of myometrium
interstitial pregnancy
71
most difficult type of ectopic to diagnost
interstitial
72
echogenic line that extends into midportion of gestational sac; represents interstitial portion of fallopian tube
interstitial line
73
Diagnostic criteria for interstitial pregnancy
empty uterine cavity
gestational sac greater than 1 cm from most lateral point of endometrial cavity
gestational sac surrounded by a thin myometrial layer
74
single interstitial portion of fallopian tube
gestational sac surrounded by myometrium separate from the uterus
demonstating a vascular peduncle adjoining gestational sac in unicornuate uterus
cornual pregnancy
75
hourglass shaped uterus from gestation expanding cervical canal
cervical pregnancy
76
gentle pressure from transducer can move gestational sac it means it is not implanted in cervix and is an impending abortion
sliding sac sign
77
gestational sac completely surrounded by myometrium with no communication with endometrial cavity
intramural pregnancy
78
trophoblast located between bladder and anterior uterine wall; fetal parts are not present in uterine cavity
cesarean scar pregnancy
79
adnexal masses
tubal ring
complex or solid adnexal mass
nonliving embryo or yolk sac
live embryo with cardiac motion
extrauterine pregnancy
80
hyperechoic ring that surrounds extrauterine gestational sac
tubal ring sign
81
gestational sac surrounded by ovarian cortex
ovarian pregnancy
82
demonstration of fetus in a gestational sac outside uterus; failure to visualize uterine wall between fetus and urinary bladder; close proximity between fetus and anterior abdominal wall; localization of placenta outside confines of uterine cavity
abdominal pregnancy
83
diagnosed upon visualization of an IUP and a concomitant extrauterine pregnancy
heterotopic pregnancy
84
complex mass-like area representing hemorrhage
rupture
85
most obvious indicator of rupture
free fluid
86
increased blood flow surrounding an ectopic gestation
ring of fire
87
aborting gestational sac Color Doppler
avascular
88
Gold standard for ectopic pregnancy
MRI
89
follows natural history; can resolve spontaneously by regression or tubal abortion
expectant management
90
success rate of expectant management
7-40%
91
antimetabolite cytotoxic drug; folic acid antagonist
methotrexate
92
success rate of methotrexrate
up to 94%
93
most successful treatment of ectopic pregnancies
laparascopy
94
An _______ is the implantation of a fertilized ovum outside of the endometrial cavity.
ectopic pregnancy
95
The three biggest risk factors are a history of _____, ______, and _____.
ectopic pregnancy
prior tubal procedure
PID
96
Beta-hCG levels rise ______ with an ectopic pregnancy than with an IUP.
slower
97
________ is the level of beta-hCG when an IUP can be visualized with sonography.
Discriminatory cutoff
98
Ectopic pregnancies most often occur in the ______, but can also be interstitial, cornual, cervical, intramural, ovarian, or abdominal.
fallopian tube
99
________ occurs when two or more fertilized ova implant, usually an IUP and an ectopic pregnancy.
heterotopic
100
The double decidual sac sign can be visualized with endovaginal sonography at _____ weeks of gestation.
4.5-5
101
The yolk sac should be visualized by ___ weeks of gestation.
5
102
The fetal pole should be visualized by _____ weeks of gestation, possibly with cardiac motion.
5.5-6
103
An ectopic pregnancy is visualized at an eccentrically located gestational sac surrounded by myometrium measuring less than __ mm/
5
104
A ________ is diagnosed by visualizing a single interstitial portion of the fallopian tube, a gestational sac surrounded by myometrium separate from the uterus, and a vascular peduncle adjoining the gestational sac to the unicornuate uterus or one horn of a bicornuate uterus
cornual pregnancy
105
A _______ may present as an hourglass-shaped uterus due to the gestation expanding the cervical canal/.
cervical pregnancy
106
An ______ is visualized as a gestational sac completely surrounded by myometrium with no communication to the endometrial cavity.
intramural pregnancy
107
______ ectopic pregnancies may be visualized as a tubal ring, a complex or solid adnexal mass, a nonliving embryo or yolk sac, or a live embryo with cardiac motion.
Extrauterine
108
_______ surrounds an ovarian pregnancy.
ovarian cortex
109
_______ are diagnosed when a fetus is visualized outside of the uterus, if no uterine wall can be seen between the fetus and the urinary bladder, if there is close proximity between the fetus and the anterior abdominal wall, or if a placenta is found outside of the uterine cavity.
abdominal pregnancies
110
Color Dopler may demonstrate a ______ around an ectopic pregnancy, but a corpus luteum may also have a similar Color Doppler pattern.
ring of fire
111
____ can confirm or better define an ectopic pregnancy; it is the gold standard for diagnosing abdominal pregnancy.
MRI
112
Treatment options for ectopic pregnancy include _______, ______, and ______.
expectant management
medical therapy
surgery
113
gestation located with the superior-lateral aspect of the endometrial cavity
eccentric pregnancy
114
Ectopic pregnancy can be caused by:
a. elevated beta-hCG
b. hypovolemic shock
c. oviduct surgical history
d. irregular sperm motility
c
115
Signs of tubal rupture may include all but:
a. hypotension
b. rebound tenderness
c. tachycardia
d. UTI
d
116
When are ectopic pregnancies usually diagnosed?
6-10 weeks
117
Beta-hCG levels should approximately double every ____ hours
48
118
At what level of beta-hCG concentration should a normal intrauterine pregnancy be seen?
1500-2500 mIU/mL
119
Interstitial pregnancy occurs in the:
intramyometrial segment of the fallopian tube
120
Ectopic pregnancy most often implant in the:
fallopian tube
121
Even though it is implanted within the uterine cavity, a cornual pregnancy is classified as an ectopic pregnancy because of its propensity to rupture in the:
second trimester
122
Cervical pregnancy is rare and linked to all of the following except:
a. previous curettage
b. ovulation induction techniques
c. endometriosis
d. IUD use
b
123
Procedures that cause an injury to the myometrium, including curettage, hysteroscopy, myomectomy, metroplasty, and cesarean section can be the cause for ____ pregnancy.
intramural
124
Heterotopic pregnancy means pregnancy:
simultaneously positioned intrauterine and extrauterine
125
What beta-hCG levels are necessary to visualize an IUP using transabdominal approach?
6500 mIU/mL
126
Which ectopic pregnancy location can support a pregnancy the longest before detection?
abdominal
127
A pseudosac:
a. is a true gestational sac positioned low in the uterine cavity
b. is a fluid collection caused by bleeding from the decidualized endometrium
c. abuts the endometrial canal
d. has a double decidual sac sign
b
128
Cervical pregnancy frequently presents on ultrasound as a(n) _____ shaped uterus.
hourglass
129
A sonographic technique that can assist in determining if a gestation is an abortion in progress versus a cervical pregnancy or cesarean scar pregnancy is:
graded compression
130
A ruptured tubal pregnancy presents as:
complex mass-like area representing hemorrhage and free fluid
131
An aborting gestational sac that will appear _____ with color Doppler.
avascular
132
If ultrasound is equivocal in the diagnosis of ectopic pregnancy, _____ may be used for diagnosis.
laparascopy
133
What imaging method is considered the "gold standard" for diagnosing and locating an abdominal ectopic pregnancy?
MRI
134
About ___ of all pregnancies in the US are ectopic.
2%
135
The pathway from the uterine cavity to the peritoneal cavity is through the ______.
fallopian tube
136
Beta-hCG levels increase and then plateau at about ______ weeks.
9-11
137
Repeated or _____ beta-hCG levels are necessary to detect an increase, decrease, or leveling of the hormone.
serial
138
When the beta-hCG level is below the discriminatory cutoff and an IUP is not visualized, this could indicate an early ______, a spontaneous abortion, or an ______ pregnancy.
normal IUP
ectopic
139
Ectopic pregnancy symptoms usually present as vaginal ______, pelvic _____, and palpable _______.
bleeding
pain
adnexal mass
140
_______ pain is the most frequent symptom seen with heterotopic pregnancy.
abdominal
141
Ovarian ____ surrounds an ovarian pregnancy.
cortex
142
Symptoms of general malaise, nausea, vomiting, vaginal bleeding, and painful fetal movements are associated with ______ ectopic pregnancy.
abdominal
143
Transvaginal sonography should demonstrate a fetal pole with cardiac motion at _____ weeks gestation.
5.5-6
144
Sonographic evaluation of ectopic pregnancy should include the _____ recess and paracolic _____ to evaluate for the extent of free fluid.
hepatorenal
gutters
145
An endometrial stripe thickness less than ____ mm suggests an abnormal or ectopic pregnancy.
8
146
Three criteria for interstitial pregnancy are _____ uterine cavity, gestational sac greater than ___ cm from the most lateral point of the endometrial cavity, and gestational sac surrounded by a thin _______ layer.
empty
1
myometrial
147
The sliding sac sign suggests an ______ in progress.
abortion
148
The yolk sac should be visualized by ____ weeks gestation.
5
149
The area most likely to collect fluid in the right abdomen between the liver and kidney is called _____.
Morison's pouch
150
Color Doppler presents as a _______ around a viable ectopic pregnancy.
ring of fire
151
In the setting of an ectopic pregnancy, the uterus may appear _____.
normal
152
MTX, known as ______, interferes with cell ______ and is used to manage ectopic pregnancy in a ______ manner.
methotrexate
division
conservative
153
Findings on physical examination of a pregnant female vary with the hemodynamic condition of the patient; hypotension, tachycardia, shoulder pain from diaphragmatic irritation, significant abdominal pain, rebound tenderness, and guarding, hypovolemic shock, or even diminished pain may all be signs of _____ and/or ______.
tubal rupture
ovarian rupture
154
