Check for errors and try again. Thank you for updating your details. Log In. Sign Up. Become a Gold Supporter and see no ads. Log in Sign up. Articles Cases Courses Quiz. About Recent Edits Go ad-free. Edit article. View revision history Report problem with Article. Citation, DOI and article data. While most women can expect to see something in a 5-week ultrasound, no two pregnancies are the same.
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A stroke can be life-threatening, so it's important to act fast. If you think a loved one is having a stroke, here's what you should and shouldn't do. A new study finds that epidurals do not affect child development in their later years. The revised criteria for diagnosing pregnancy failure are as follows Table 2. On US, these appear as either hyperechoic or hypoechoic, depending upon the age of the blood products Figure 7.
Most often these are not associated with any significant clinical sequelae, particularly if fetal cardiac activity is present. Centers for Disease Control and Prevention in The vast majority of ectopic pregnancies occur within the fallopian tube tubal ectopic. Less common locations include interstitial cornual , cervical, within a cesarean section scar, or ovarian. Occasionally, the only US finding will be free fluid.
More often, an adnexal tubal ring is identified. On US this consists of an echogenic ring with central fluid, separate from the ovary. The ring may or may not contain a yolk sac or embryo.
The ring is typically more echogenic than the ring of a corpus luteum, with which it can potentially be confused Figure 9. Endovaginal transducer pressure on the ovary can help determine if the lesion is within or separate from the ovary. As ovarian ectopic pregnancies are exceedingly rare, demonstrating an intra-ovarian location confirms a corpus luteum and essentially excludes an ectopic mass. Often, the ectopic may be identified only as an extra-ovarian adnexal mass, without the classic ring-like appearance, because of hemorrhage.
While the presence of color flow helps to confirm an ectopic pregnancy mass, the converse is not always true. Not all ectopics are vascular, and the absence of color Doppler flow does not exclude an ectopic pregnancy. While large amounts of hemorrhage typically indicate a ruptured ectopic, occasionally a ruptured hemorrhagic cyst can present with a similar clinical and US picture.
When an ectopic pregnancy implants within the interstitial segment of the fallopian tube, it is termed an interstitial or cornual ectopic. These can be mistaken for IUP if not fully investigated, as they can have a normal interface with the endometrium along their inner margin. Additionally, the distinction from tubal ectopics is important, as cornual pregnancies have an increased risk of severe hemorrhage and mortality.
The interstitial location can be identified by the eccentric location high within the uterus, as well as by the presence of only a thin mantle of myometrium along the outer margin, usually less than 5 mm thick.
As with interstitial ectopic pregnancies, the risk of significant bleeding and mortality is increased with cervical ectopics relative to tubal ectopics. The gestational sac in a cervical ectopic pregnancy must be distinguished from a gestational sac passing through the cervix during an abortion in progress. In the case of a cervical ectopic, the gestational sac usually maintains its normal round or slightly ovoid shape.
Additionally, the presence of perigestational blood flow on color Doppler can aid in the distinction Figure Ectopic pregnancy can be managed medically or surgically.
Imaging features that influence management include the size of the ectopic; presence of embryonic cardiac activity, pelvic hemorrhage or tubal rupture; and the location of the ectopic. Nonsurgical techniques include systemic methotrexate or ultrasound-guided local injection of methotrexate or KCl.
For tubal ectopics, salpingostomy or salpingectomy may be performed. Interstitial ectopics may require cornual resection or hysterectomy.
Cesarean section or cervical ectopics may require a combination of medical and surgical therapy. Retained products of conception RPOC can be found following therapeutic or spontaneous abortion, as well as post-partum.
The presence of a retained gestational sac is not a diagnostic dilemma but is rarely encountered. The presence of blood flow within a thickened endometrium, particularly when associated with a visible mass, is highly suggestive of RPOC Figure Arteriovenous malformations AVMs of the uterus can be either congenital or acquired; and can be encountered in the setting of prior therapeutic abortion, dilatation and curettage, cesarean section or invasive tumor such as endometrial carcinoma or gestational trophoblastic disease.
US usually demonstrates a complex mass, with color Doppler revealing internal flow Figure There, they can scan and obtain quantitative Beta hCG pregnancy hormone measurements that combined with a scan can offer further information, but again, it may be that watching and waiting that would be the appropriate course of action. More on ectopic pregnancy later What will I see at a 5 week early pregnancy scan, why should I wait until 7 weeks?
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