Ectopic Pregnancy Flashcards
What ultrasonic features suggest ectopic pregnancy?
Adnexal mass Free fluid Absence of intrauterine gestation Possible pseudo gestational sac Always check kidneys for free fluid
How often do you only see a pseudo gestational sac in ectopic pregnancies?
20%
What are the differential diagnosis for ectopic pregnancies?
Early gestation- <5 weeks/bHCG increase
Aborted pregnancy- bHCG decrease
PID- bHCG negative
Ovarian cyst- bHCG negative
Endometriosis- bHCG negative
What are some abnormal reasons to bleed during pregnancy?
Malignancies Fibroids Polyps Adenomyosis PID Endometriosis Ectopic pregnancy Hydatidiform mole (choriocarcinoma) Ovarian tumors Placenta Previa Abruptio placenta
When can the gestational sac be seen?
4 weeks
When is the gestational sac reliable when seen?
6 weeks
By how many weeks should the gestational sac take up half the total uterine volume?
8 weeks
Describe threatened abortion
- vaginal bleeding
- US shows normal pregnancy
- may have cramping
- possible implantation bleed
Describe anembryonic pregnancy
- gestational sac develops but the embryo doesnt
- slight bleeding
- pregnancy test due to HCG
- grow of sac stops and usually aborts
- doctors may intervene with D&C
What is another name for a anembryonic pregnancy?
Brightened ovum
What is the sonographic appearance for an anembryonic pregnancy?
- see small for dates given
- see large sac without presence of fetus
- trophoblastic ring with irregular borders
- see blood fluid levels
When are you supposed to follow up when you see an embryo <2.5cm?
10 days
Describe a embryonic demise
Fetus dies but remains in the embryo
Some bleeding may occur
The uterus is small for dates
What is another name for a embryonic demise?
Missed abortion
When do embryonic demise usually occur between?
10-14 weeks
What is the sonographic appearance of a embryonic demise?
No FHB
Macerated fetus- edematous tissue
Spaulding sign- overlapping of the skull bones
Placenta and sac may be in process of digestion
Describe inevitable abortion?
Pt appears with active bleeding and an open cervix
Cramping is common
What is the sonographic appearance of a inevitable demise?
Open cervix Possibly containing clot Detached placenta May see viable fetus Sac may be in the lower uterine segment
What is a incomplete abortion?
A threatened abortion that has progressed
Describe a incomplete abortion
Some of the products of conception have been passed as tissue with the bleeding
Parts remain resulting in continual bleeding
Enlarged uterus
What is the sonographic appearance of a incomplete abortion?
Empty ill-defined gestational sac with some internal echos no resembling a fetus
May see a hyperechoic area in the lower segment
What is a complete abortion?
All products of conception have been passed
What is the sonographic appearance of a complete abortion?
Bleeding
Cramping
Passing of tissue
Open cervix
What is a habitual abortion?
Having 3 or more consecutive abortions
What is a septic abortion?
Infected products may occur after a spontaneous abortion or induced abortion
What are the symptoms of a septic abortion?
Pain
Fever
Bleeding
Discharge
What is the sonographic appearance of a septic abortion?
May seen retained products
Enlarged uterus - increased echos with gas producing organisms
What are some malformations detectable in utero that are classified as selectable abortions?
- Anencephaly
- Porencephly
- Encephalocele
- severe hydrocephalus
- severe chromosomal abnormalities
- renal agenesis or bilateral polycystic dx
- inherited chromosomal, metabolic and hematologic abnormalities
What is the method of termination less then 14 weeks?
D&C
What is the method of termination when greater then 14 weeks?
Induce labor with hypertonic saline urea
prostaglandin
D&C
When terminating a pregnancy greater then 14 weeks, what are the increased risks?
Retained products
Endometrisis
Uterine perforation with D&C
