Ectopic Pregnancy Susana Smith Harbutt February, 2013 Dr. Joy Sclamberg.

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Presentation transcript:

Ectopic Pregnancy Susana Smith Harbutt February, 2013 Dr. Joy Sclamberg

HPI: The patient is a 36 year old G10P6030 at 8 weeks by LMP with PMH of 2 ectopic pregnancies treated with MTX who presents 7 days follow-up of medical management of ectopic pregnancy. She originally presented to OSH on 1/27/10 for 10/10 abdominal pain and was found to have +beta HCG and right adnexal mass. She presented to Rush for second opinion. She received MTX for medical management of the ectopic pregnancy and her beta-HCG have continued to trend upwards. Physical Exam: Vitals: BP: 111/68 mmHg Pulse: 74 Temp: 98.4 °F (36.9 °C) Resp: 18 General: alert and oriented, NAD Lungs: Clear bilaterally Heart: S1, S2+, RRR Abdomen- soft, minimal suprapubic ttp, no rebound or guarding Bimanual exam- mild suprapubic tenderness, no CMT, no adnexal tenderness Clinical History and Physical Exam 2

Ectopic Pregnancy Hemorrhagic Cyst – key findings clot retraction and fibrin strands Ovarian torsion – findings include enlarged edematous ovary. Doppler findings can vary, lack of doppler makes the diagnosis. Pelvic Inflammatory Disease – findings include thickened tubal wall, hyperemia or increased vascularity of the fallopian tube. Appendicitis Paratubal cyst Working Diagnosis

Discriminatory HCG: level at which an intrauterine pregnancy should be detected by ultrasound. If not present than abnormal or ectopic gestation is likely. Beta HCG

Ultrasound MRI CT Diagnostic Imaging Options

ACR Criteria

Ultrasound

Double Decidua Sign Normal Pregnancy

Yolk Sac and Embryo Yolk Sac at 5 weeks

Uterus Transvaginal Ultrasound

Cervix Transvaginal Ultrasound

Right Adnexa Transvaginal Ultrasound

Right Ovary Transvaginal Ultrasound

Right Ovary Transvaginal Ultrasound

Left Adnexa Transvaginal Ultrasound

Left Adnexa Transvaginal Ultrasound

Left Adnexa Transvaginal Ultrasound

Gestational Sac Transvaginal Ultrasound

Gestational Sac Transvaginal Ultrasound

Yolk Sac Transvaginal Ultrasound

Embryo – Fetal Pole Transvaginal Ultrasound

Left Adnexa Transvaginal Ultrasound

“Ring of Fire” Transvaginal Doppler Ultrasound

Operative laparoscopy with removal of ectopic pregnancy and salpingectomy Pathology Report: Treatment

MRN: Accession: Adam, Andy. Grainger & Allison's Diagnostic Radiology, 5th ed. Chapter 53 Imaging in Obstetrics and Infertility. Churchill Linvingstone 2008 Barnhart, Kurt T., M.D., M.S.C.E Ectopic Pregnancy. N Engl J Med 2009; 361:379-3 July 23, 2009DOI: /NEJMcp July 23, 2009DOI: /NEJMcp Levine, Deborah. Ectopic Pregnancy. Radiology : Case and References 25