초음파 통계 OBGYhyster o Dop 정밀정밀 양수양수 3DBPP 합계 ~ ~

Ectopic pregnancy 이 O 희 (F/27 )

 C.C : 일 인공유산 ( 임신 12 주 말. 우성 산부인과 ) 이후 LOW ABD DISCOMFORT.  임신 12 주경 AA (LMP 11 월 말 )  post artificial abortion #12  --> adequate amount of gestational tissue 였다고 함  (local 소견서, 우성병원 담당의 통화함 )  3-4 일전부터 하복부가 콕콕 쑤시는 느낌  local --> 애기집 있다 듣고 내원  self urine hCG - test line 은 weak 했음  VD yellowish, watery  OB Hx : G(2)P(0) AA(2)

USG

 uterus  position: AVF  size:9.3X6.9X5.0cm  endometrium: 0.6cm  abn. findings: NO G- sac in Ut. cavity.

USG

 Rt. Ov 아래로 uterus 의 Rt. posterior 위치의 8.9X5.5cm 안에 13 주 크기의 fetus 보입니다. (BPD : 1.95cm 13w / FL : 0.77cm 12w2d)

USG

 Imp> preg at 13wks c ectopic preg.  r/o abdominal preg.  r/o tubal preg.  r/o combined preg.

1. About 7.6 X 5.1cm sized heterogenous high SI on T2WI lesion with fetus in internal portion, Rt. posterior aspect of uterus.(focal abutting to uterus) --> C/W Ectopic pregnancy. 2. Intact, ampulla & fimbria of both fallopian tube( image #10, T2WI) 3. Intact, both ovaries. 4. Hypertrophic change of uterus. 5. No evidence of obstructive pattern in covered bowel loops. 6. No evidence of hemoperitoneum nor ascites. CT

Operation  Ut. - normal sized, 9.5X7x 5.0cm sized smooth surface Both ovary; intact Rt salpinx end 에 9x6cm sized ectopic focus (+) unruptured state Rt adnexa 에 omentum adhesion(+) -> adhesiolysis Uterus posterior 에 inflammation 에 의한 both adnexa serosa 및 omentum adhesion (+) -> adhesiolysis  RS done (but, mesosalpinx intact)  left ovary intact 확인  tube ->obliteration  -> staff 박종민, salpingo-neoplasty done  but r/o chronic salipingitis 에 의한 tube wall 이 두꺼워진 소견으로 patency 유지 및 fertility 확보 어려울 것으로 보인다 함. OP Name : Explo- RS, Left salpingo-neoplasty, Adhesiolysis

Ectopic pregnancy 1. Ectopic pregnancy 2. Heterotpic pregnancy 3. Abdominal pregnancy

Ectopic pregnancy Tubal (97.7%) : interstitial(2-4%), isthmus (20-25%) ampulla portion(75%) Ovarian (0.5%) Cervical (0.1%) Abdominal (0.03%)

Ectopic pregnancy  Symptoms: - Abdominal pain ( %) - Amenorrhea (75 -90%) - Vaginal bleeding (50 -80%) - Passage of tissue (5 -10%)  Physical findings : - Abdominal tenderness (75-95%) - Adnexal tenderness (54%)

Heterotopic pregnancy  Definition: Simultaneous development of a gestation within the uterine cavity and a gestation outside the uterine cavity.  Prevalence: 0.6 ‑ 2.5:10,000 pregnancies. - increase in the incidence of heterotopic pregnancy in women undergoing ovulation induction. - An even greater incidence of heterotopic pregnancy is reported in pregnancies following assisted reproduction techniques such as In Vitro Fertilization (IVF) and Gamete Intra ‑ Fallopian Transfer (GIFT).

 Differential diagnosis: Normal intrauterine pregnancy, a normal intrauterine pregnancy and a ruptured ovarian cyst, a corpus luteum, or an appendicitis.  Prognosis: The prognosis for the extrauterine fetus is very poor, having an estimated 90 ‑ 95% mortality rates. The mortality rate for the intrauterine pregnancy is approximately 35%.  Management: Surgical removal of the ectopic gestation by salpingectomy or salpingostomy. Expectant management has been successfully applied in select cases. Successful salpingocentesis has also been reported.

Abdominal pregnancy  rare.  typically develops in the ligaments of the ovary, usually the broad ligament.  blood supply from the omentum and abdominal organs.  Sono- separate from the uterus, adnexa, and ovaries.  Treatment is by laparotomy or laparoscopy.  Abdominal pregnancy can result in a life-threatening emergency. However, if diagnosed late in gestation, a viable pregnancy can result.

MR Imaging and MR Angiography of an Abdominal Pregnancy with Placental Infarction Vartan Malian1 and J. H. Edmund Lee  33-year-old woman (G2P0)with abdominal pregnancy(18weeks) and placental infarcts.  show abdominal pregnancy with areas of hypointensity (arrows) corresponding to infarction in superior and inferior placenta. No uterine invasion by placenta is present. Department of Diagnostic Radiology, University of California Davis Medical Center AJR.Dec.2001