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OB 1 > Chapter 19: Sonographic Assessment of the Ectopic Pregnancy > Flashcards

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

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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

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3
Q

glycoprotein hormone produced in pregnancy made by developing embryo soon after conception and later by the placenta

A

beta-hCG

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4
Q

gestation located within the endocervical canal

A

cervical pregnancy

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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

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6
Q

level of beta-hCG at which a normal intrauterine pregnancy can be seen with sonography

A

Discriminatory cutoff

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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

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8
Q

implantation of a fertilized ovum in any area outside of the endometrial cavity

A

ectopic pregnancy

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9
Q

concomitant intrauterine pregnancy and ectopic pregnancy

A

heterotopic pregnancy

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10
Q

life-threatening condition due to a decrease in blood volume

A

hypovolemic shock

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11
Q

gestation located in the intramyometrial segment of the fallopian tube

A

interstitial pregnancy

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12
Q

gestation located within the myometrium of the uterus

A

intramural pregnancy

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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)

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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

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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

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16
Q

Gestation located within the ovary

A

ovarian pregnancy

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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

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18
Q

pregnancy in which no signs of an intrauterine pregnancy or ectopic pregnancy are seen on sonography

A

pregnancy of unknown location (PULS)

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19
Q

when gentle pressure from the transducer moves he gestational sac

A

sliding sac sign

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20
Q

hyperechoic ring of trophoblastic tissue that surrounds an extrauterine gestational sac

A

tubal ring sign

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21
Q

Ectopic pregnancy accounts for ___ of all pregnancies in the US.

A

2%

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22
Q

Leading cause of maternal death in the first trimester

A

ectopic pregnancy

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23
Q

Where is the fallopian tube derived from?

A

Mullerian duct system

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24
Q

Only connection between peritoneal and endometrial cavity

A

fallopian tube

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25
Q

Key risk factors to ectopic pregnancy

A

history of ectopic pregnancy
prior tubal surgical procedures
PID

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26
Q

History of PID increases the risk of ectopic _____.

A

sevenfold

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27
Q

Key findings of ectopic pregnancy

A

vaginal bleeding
pelvic pain
palpable adnexal mass

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28
Q

When is an ectopic pregnancy typically diagnosed?

A

6-10 weeks

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29
Q

Beta-hCG plateaus at ____ weeks.

A

9-11

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30
Q

In a normal IUP, the beta hCG should ____ every 48 hours.

A

double

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31
Q

level of beta-hCG at which a normal IUP can be seen with ultrasound

A

discriminatory cutof

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32
Q

discriminatory cutoff endovaginal

A

above 1,500 to 2,500 mIU/mL

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33
Q

Differential diagnosis is discriminatory cutoff below and IUP not visualized

A

early normal IUP
spontaneous abortion
ectopic pregnancy

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34
Q

implants within uterine cavity above level or internal os, medial to interstitial portion of fallopian tubes, eccentrically within uterine cavity

A

normal intrauterine gestation

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35
Q

How often is an ectopic implanted in the fallopian tubes?

A

95%

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36
Q

What part of fallopian tube does an ectopic usually occur?

A

ampullary

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37
Q

What three segments of fallopian tube can you find a tubal ectopic?

A

ampullary, isthmus, fimbria

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38
Q

occurs in intramyometrial segment of fallopian tube

A

interstitial pregnancy

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39
Q

Interstitial pregnancies account for ___ of all ectopics.

A

2-4%

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40
Q

How late can an interstitial pregnancy go on without symptoms?

A

16 weeks

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41
Q

increased risks for interstitial pregnancy

A

prior ipsilateral salpingectomy
IVF

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42
Q

occurs within a rudimentary uterine horn or one horn of a bicornuate or septate uterus

A

Cornual pregnancy

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43
Q

Why is a cornual pregnancy classified as ectopic?

A

propensity to rupture in the second trimester

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44
Q

Cornual pregnancy accounts for ______ of all ectopics/

A

less than 1%

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45
Q

five different locations of pregnancy that occur in cornual region of uterus

A

interstitial
rudimentary horn of unicornuate uterus
horn of bicornuate uterus
horn of septate uterus
angular pregnancie

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46
Q

located eccentrically within endometrial cavity near uterotubal junction

A

angular pregnancies

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47
Q

occurs when gestation implants within the endocervical canal

A

cervical pregnancy

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48
Q

Cervical pregnancy accounts for _____ of ectopic pregnancies

A

less than 1%

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49
Q

increased risk factors for cervical pregnancy

A

previous currettage
anatomic anomalies
endometriosis
IUD use

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50
Q

occurs by implantation of the gestation within the myometrium of the uterus

A

intramural pregnancy

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51
Q

Intramural pregnancy accounts for _____ of all ectopic pregnancies.

A

less than 1%

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52
Q

occurs when fertilized ovum implants in ovary

A

ovarian pregnancy

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53
Q

Ovarian pregnancy accounts for ____ of all ectopic pregnancies.

A

1-3%

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54
Q

occurs when ovum implants within intraperitoneal cavity, aside from tubal, ovarian, or intraligamentous sites

A

abdominal pregnancy

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55
Q

Abdominal pregnancy accounts for ____ of all ectopic pregnancies.

A

up to 1.4%

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56
Q

occurs when fertilized ovum implants within intraperitoneal cavity

A

primary abdominal pregnancy

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57
Q

occurs when a tubal ectopic pregnancy ruptures or aborts and reimplants within intraperitoneal cavity

A

secondary abdominal pregnancy

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58
Q

occurs when two or more fertilized ova implant

A

heterotopic pregnacy

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59
Q

Most frequent symptom of heterotopic pregnancy

A

abdominal pain

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60
Q

pelvic mass in patients with low or absent beta-hcG levels and minimal symptoms

A

chronic ectopic pregnancy

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61
Q

What is the discriminatory cutoff from transabdominal sonography?

A

more than 6500 mIU/mL

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62
Q

On an endovaginal scan, the gestational sac with a double decidual sac sign can be seen at ___ weeks.

A

4.5-5

63
Q

On an endovaginal scan, the yolk sac can be seen at ___ weeks.

A

5

64
Q

On an endovaginal scan, the fetal pole with cardiac motion can be seen at _____ weeks.

A

5.5-6

65
Q

inconclusive transvaginal sonogram with declining beta-hCG levels to undetectable levels without an IUP or ectopic gestation identification

A

trophoblast in regression

66
Q

hepatorenal recess

A

Morison’s pouch

67
Q

The endometrial stripe thickness should be less than __ mm

A

8

68
Q

fluid collection caused by bleeding from decidualized endometriam

A

pseudosac

69
Q

The ______ abuts the endometrial canal.

A

gestational sac

70
Q

eccentrically located gestational sac surrounded by very thin layer of myometrium

A

interstitial pregnancy

71
Q

most difficult type of ectopic to diagnost

A

interstitial

72
Q

echogenic line that extends into midportion of gestational sac; represents interstitial portion of fallopian tube

A

interstitial line

73
Q

Diagnostic criteria for interstitial pregnancy

A

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
Q

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

A

cornual pregnancy

75
Q

hourglass shaped uterus from gestation expanding cervical canal

A

cervical pregnancy

76
Q

gentle pressure from transducer can move gestational sac it means it is not implanted in cervix and is an impending abortion

A

sliding sac sign

77
Q

gestational sac completely surrounded by myometrium with no communication with endometrial cavity

A

intramural pregnancy

78
Q

trophoblast located between bladder and anterior uterine wall; fetal parts are not present in uterine cavity

A

cesarean scar pregnancy

79
Q

adnexal masses
tubal ring
complex or solid adnexal mass
nonliving embryo or yolk sac
live embryo with cardiac motion

A

extrauterine pregnancy

80
Q

hyperechoic ring that surrounds extrauterine gestational sac

A

tubal ring sign

81
Q

gestational sac surrounded by ovarian cortex

A

ovarian pregnancy

82
Q

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

A

abdominal pregnancy

83
Q

diagnosed upon visualization of an IUP and a concomitant extrauterine pregnancy

A

heterotopic pregnancy

84
Q

complex mass-like area representing hemorrhage

A

rupture

85
Q

most obvious indicator of rupture

A

free fluid

86
Q

increased blood flow surrounding an ectopic gestation

A

ring of fire

87
Q

aborting gestational sac Color Doppler

A

avascular

88
Q

Gold standard for ectopic pregnancy

A

MRI

89
Q

follows natural history; can resolve spontaneously by regression or tubal abortion

A

expectant management

90
Q

success rate of expectant management

A

7-40%

91
Q

antimetabolite cytotoxic drug; folic acid antagonist

A

methotrexate

92
Q

success rate of methotrexrate

A

up to 94%

93
Q

most successful treatment of ectopic pregnancies

A

laparascopy

94
Q

An _______ is the implantation of a fertilized ovum outside of the endometrial cavity.

A

ectopic pregnancy

95
Q

The three biggest risk factors are a history of _____, ______, and _____.

A

ectopic pregnancy
prior tubal procedure
PID

96
Q

Beta-hCG levels rise ______ with an ectopic pregnancy than with an IUP.

A

slower

97
Q

________ is the level of beta-hCG when an IUP can be visualized with sonography.

A

Discriminatory cutoff

98
Q

Ectopic pregnancies most often occur in the ______, but can also be interstitial, cornual, cervical, intramural, ovarian, or abdominal.

A

fallopian tube

99
Q

________ occurs when two or more fertilized ova implant, usually an IUP and an ectopic pregnancy.

A

heterotopic

100
Q

The double decidual sac sign can be visualized with endovaginal sonography at _____ weeks of gestation.

A

4.5-5

101
Q

The yolk sac should be visualized by ___ weeks of gestation.

A

5

102
Q

The fetal pole should be visualized by _____ weeks of gestation, possibly with cardiac motion.

A

5.5-6

103
Q

An ectopic pregnancy is visualized at an eccentrically located gestational sac surrounded by myometrium measuring less than __ mm/

A

5

104
Q

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

A

cornual pregnancy

105
Q

A _______ may present as an hourglass-shaped uterus due to the gestation expanding the cervical canal/.

A

cervical pregnancy

106
Q

An ______ is visualized as a gestational sac completely surrounded by myometrium with no communication to the endometrial cavity.

A

intramural pregnancy

107
Q

______ 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.

A

Extrauterine

108
Q

_______ surrounds an ovarian pregnancy.

A

ovarian cortex

109
Q

_______ 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.

A

abdominal pregnancies

110
Q

Color Dopler may demonstrate a ______ around an ectopic pregnancy, but a corpus luteum may also have a similar Color Doppler pattern.

A

ring of fire

111
Q

____ can confirm or better define an ectopic pregnancy; it is the gold standard for diagnosing abdominal pregnancy.

A

MRI

112
Q

Treatment options for ectopic pregnancy include _______, ______, and ______.

A

expectant management
medical therapy
surgery

113
Q

gestation located with the superior-lateral aspect of the endometrial cavity

A

eccentric pregnancy

114
Q

Ectopic pregnancy can be caused by:
a. elevated beta-hCG
b. hypovolemic shock
c. oviduct surgical history
d. irregular sperm motility

A

c

115
Q

Signs of tubal rupture may include all but:
a. hypotension
b. rebound tenderness
c. tachycardia
d. UTI

A

d

116
Q

When are ectopic pregnancies usually diagnosed?

A

6-10 weeks

117
Q

Beta-hCG levels should approximately double every ____ hours

A

48

118
Q

At what level of beta-hCG concentration should a normal intrauterine pregnancy be seen?

A

1500-2500 mIU/mL

119
Q

Interstitial pregnancy occurs in the:

A

intramyometrial segment of the fallopian tube

120
Q

Ectopic pregnancy most often implant in the:

A

fallopian tube

121
Q

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:

A

second trimester

122
Q

Cervical pregnancy is rare and linked to all of the following except:
a. previous curettage
b. ovulation induction techniques
c. endometriosis
d. IUD use

A

b

123
Q

Procedures that cause an injury to the myometrium, including curettage, hysteroscopy, myomectomy, metroplasty, and cesarean section can be the cause for ____ pregnancy.

A

intramural

124
Q

Heterotopic pregnancy means pregnancy:

A

simultaneously positioned intrauterine and extrauterine

125
Q

What beta-hCG levels are necessary to visualize an IUP using transabdominal approach?

A

6500 mIU/mL

126
Q

Which ectopic pregnancy location can support a pregnancy the longest before detection?

A

abdominal

127
Q

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

A

b

128
Q

Cervical pregnancy frequently presents on ultrasound as a(n) _____ shaped uterus.

A

hourglass

129
Q

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:

A

graded compression

130
Q

A ruptured tubal pregnancy presents as:

A

complex mass-like area representing hemorrhage and free fluid

131
Q

An aborting gestational sac that will appear _____ with color Doppler.

A

avascular

132
Q

If ultrasound is equivocal in the diagnosis of ectopic pregnancy, _____ may be used for diagnosis.

A

laparascopy

133
Q

What imaging method is considered the “gold standard” for diagnosing and locating an abdominal ectopic pregnancy?

A

MRI

134
Q

About ___ of all pregnancies in the US are ectopic.

A

2%

135
Q

The pathway from the uterine cavity to the peritoneal cavity is through the ______.

A

fallopian tube

136
Q

Beta-hCG levels increase and then plateau at about ______ weeks.

A

9-11

137
Q

Repeated or _____ beta-hCG levels are necessary to detect an increase, decrease, or leveling of the hormone.

A

serial

138
Q

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.

A

normal IUP
ectopic

139
Q

Ectopic pregnancy symptoms usually present as vaginal ______, pelvic _____, and palpable _______.

A

bleeding
pain
adnexal mass

140
Q

_______ pain is the most frequent symptom seen with heterotopic pregnancy.

A

abdominal

141
Q

Ovarian ____ surrounds an ovarian pregnancy.

A

cortex

142
Q

Symptoms of general malaise, nausea, vomiting, vaginal bleeding, and painful fetal movements are associated with ______ ectopic pregnancy.

A

abdominal

143
Q

Transvaginal sonography should demonstrate a fetal pole with cardiac motion at _____ weeks gestation.

A

5.5-6

144
Q

Sonographic evaluation of ectopic pregnancy should include the _____ recess and paracolic _____ to evaluate for the extent of free fluid.

A

hepatorenal
gutters

145
Q

An endometrial stripe thickness less than ____ mm suggests an abnormal or ectopic pregnancy.

A

8

146
Q

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.

A

empty
1
myometrial

147
Q

The sliding sac sign suggests an ______ in progress.

A

abortion

148
Q

The yolk sac should be visualized by ____ weeks gestation.

A

5

149
Q

The area most likely to collect fluid in the right abdomen between the liver and kidney is called _____.

A

Morison’s pouch

150
Q

Color Doppler presents as a _______ around a viable ectopic pregnancy.

A

ring of fire

151
Q

In the setting of an ectopic pregnancy, the uterus may appear _____.

A

normal

152
Q

MTX, known as ______, interferes with cell ______ and is used to manage ectopic pregnancy in a ______ manner.

A

methotrexate
division
conservative

153
Q

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 ______.

A

tubal rupture
ovarian rupture

154
Q
A

OB 1 (16 decks)

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