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Ectopic Pregnancy

Diagnosis 1

Clinical Features.

Definition

Confirm with

  • Serial evaluation with EITHER or BOTH:
    • serum hCG
    • TVUS
  • Visualisation at surgery.

Radiology

TV Ultrasound

Sensitivity 73 - 93% for Dx of Ectopic.
Visualisation of ectopic = Confirm diagnosis.
Visualisation of intrauterine = Makes Ectopic very unlikely but heterotopic possible.

Findings

  1. Tubal Ectopic Pregnancy.

    • Extrauterine sac with fetal pole +/- heart.
    • Adnexal mass with hypoechoic ring around gestational sac = 'Ring sign'
    • Adnexal mass separate from ovary.

  2. Extratubal Ectopic Pregnancy.

    1. Cervical Ectopic
      • Empty Uterus.
      • Barrel - shaped cervix.
      • Gestational sac below cervical os.
      • Absence of 'sliding sign' = ie does not move with pressure which a form fruste of miscarriage would do.
    2. Caesarian Scar
      • Empty uterus.
      • Gestational sac or solid mass of trophoblast.
      • Thin/absent layer of myometrium between sac and bladder.
      • Prominent trophoblastic / placental circulation on Doppler.
      • Empty endocervical canal.
    3. Interstitial Pregnancy.
    4. Cornual Pregnancy.
    5. Abdominmal Pregnancy.
    6. Ovarian Ectopic Pregnancy.

Footnotes

  1. DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T115772, Ectopic Pregnancy; [updated 2018 Nov 30, 2021 Sep 14] ↩