ECTOPIC PREGNANCY: QUESTIONS AND ANSWERS
LATEST UPDATE (GRADED A+)
Abdominal pregnancy
Gestation located within the intraperitoneal cavity, apart from tubal, ovarian, or intraligamentous sites
Assisted reproductive techniques (ART)
A number of techniques used to aid fertilization, including in vitro fertilization (IVF), intracytoplasmic
sperm insertion (ICSI), follicle aspiration, sperm injection, and assisted follicular rupture (FASIAR)
Clinical presentation
-none
-vaginal bleeding
-pain
-palpable adnexal mass
-amenorrhea
-hypotension
-shoulder pain
-rebound tenderness
-gaurding
-hypovolemic shock
B-hCG levels
Lower than normal value
Nonvisualization of pregnancy at discriminatory level
1500-2500mIU/mL
Most common site
Fallopian tube (95%)
Heterotopic pregnancy
Ectopic with intrauterine pregnancy. Very Rare!
Sonographic protocol
Ovary, uterus, IUP vs Ectopic, embryonic heart beat, color Doppler, morisons pouch
Sonographic appearance: Uterus
Normal appearance, thickened endometrium ➡️8mm
Pseudosac
Double decidual sac sign
Sonographic findings: interstitial
, Eccentrically located gestational sac
Thin layer of myometrium
Empty uterine cavity
Gestational sac:
>1cm from most lateral point
Surrounded by thin myometrial layer
Sonographic findings: coronal
Located in interstitial portion of Fallopian tube
Sac surrounded by myometrium
Vascular pedicle
Occurs in unicornuate/bicornuate uterus
Sonographic findings: cervical
Hourglass shaped sac in cervix
Pending abortion vs ectopic
Sliding sign
Sac moves with endovaginal transducer pressure
Sonographic findings: intramural
Sac surrounded by myometrium
Can occur in C-section
No embryonic/fetal parts in uterine cavity
Myometrium between uterus and bladder
Trophoblast between bladder and anterior uterine wall
Sonographic findings: extrauterine
Adnexal mass imaging as: tubal ring, complex/solid mass, nonviable embryo, yolk sac
Sonographic findings: ovarian
Normal tube
Gestational sac on ovary
Ovary and gestational sac connected by the ovarian ligament
Placental tissue mixed with ovarian cortex
Sonographic findings: abdominal
Fetus outside of uterus
Failure to image uterine wall between fetus and urinary bladder
Close proximity to maternal anterior abdominal wall
Localization of placenta outside of uterus
Acute rupture
LATEST UPDATE (GRADED A+)
Abdominal pregnancy
Gestation located within the intraperitoneal cavity, apart from tubal, ovarian, or intraligamentous sites
Assisted reproductive techniques (ART)
A number of techniques used to aid fertilization, including in vitro fertilization (IVF), intracytoplasmic
sperm insertion (ICSI), follicle aspiration, sperm injection, and assisted follicular rupture (FASIAR)
Clinical presentation
-none
-vaginal bleeding
-pain
-palpable adnexal mass
-amenorrhea
-hypotension
-shoulder pain
-rebound tenderness
-gaurding
-hypovolemic shock
B-hCG levels
Lower than normal value
Nonvisualization of pregnancy at discriminatory level
1500-2500mIU/mL
Most common site
Fallopian tube (95%)
Heterotopic pregnancy
Ectopic with intrauterine pregnancy. Very Rare!
Sonographic protocol
Ovary, uterus, IUP vs Ectopic, embryonic heart beat, color Doppler, morisons pouch
Sonographic appearance: Uterus
Normal appearance, thickened endometrium ➡️8mm
Pseudosac
Double decidual sac sign
Sonographic findings: interstitial
, Eccentrically located gestational sac
Thin layer of myometrium
Empty uterine cavity
Gestational sac:
>1cm from most lateral point
Surrounded by thin myometrial layer
Sonographic findings: coronal
Located in interstitial portion of Fallopian tube
Sac surrounded by myometrium
Vascular pedicle
Occurs in unicornuate/bicornuate uterus
Sonographic findings: cervical
Hourglass shaped sac in cervix
Pending abortion vs ectopic
Sliding sign
Sac moves with endovaginal transducer pressure
Sonographic findings: intramural
Sac surrounded by myometrium
Can occur in C-section
No embryonic/fetal parts in uterine cavity
Myometrium between uterus and bladder
Trophoblast between bladder and anterior uterine wall
Sonographic findings: extrauterine
Adnexal mass imaging as: tubal ring, complex/solid mass, nonviable embryo, yolk sac
Sonographic findings: ovarian
Normal tube
Gestational sac on ovary
Ovary and gestational sac connected by the ovarian ligament
Placental tissue mixed with ovarian cortex
Sonographic findings: abdominal
Fetus outside of uterus
Failure to image uterine wall between fetus and urinary bladder
Close proximity to maternal anterior abdominal wall
Localization of placenta outside of uterus
Acute rupture
