JOURNAL READING

Ectopic Pregnancy
Preceptor :
dr. Munir, Sp. Rad
Student :
Andrew Lienata 07120110066

Kepaniteraan Ilmu Radiologi

Fakultas Kedokteran Universitas Pelita Harapan
RS Bhayangkara Tingkat I Raden Said Sukanto

Ultrasonography
Diagnostic sonography (ultrasonography)
is
an
ultrasound-based
diagnostic
imaging technique used for visualizing
internal body structures including tendon,
muscles, joints, vessels, and internal
organs for possible pathology or lesion.
The practice of examining pregnant
women using ultrasound is called
obstrectic sonography.

Advantages compared with other

techniques

Ultrasound examinations are non-invasive i.e. they

do not require the body to be opened up, or anything to
be inserted into the body. This is a major advantage
compared to fibre-optic endoscopy, for example, which
may involve much more patient discomfort as the probe
is inserted.
Ultrasound methods are relatively inexpensive,
quick and convenient, compared to techniques such
as X-rays or MRI scans. The equipment can be made
portable, and the images can be stored electronically.
No harmful effects have been detected, at the
intensity levels used for examinations and imaging. This
contrasts with methods based on X-rays or on
radioactive isotopes, which have known risks associated
with them, and ultrasound methods are preferred
whenever possible. This is particularly relevant to
examination of expectant mothers.

Disadvantages of ultrasound compared with

other techniques
The major disadvantage is that the resolution of
images is often limited. This is being overcome as
timepasses, but there are still many situations where Xrays produce a much higher resolution.
Ultrasound is reflected very strongly on passing
from tissue to gas, or vice versa. This means that
ultrasound cannot be used for examinations of areas of the
body containing gas, such as the lung and the digestive
system.
Ultrasound also does not pass well through bone, so
that the method is of limited use in diagnosingfractures. It
is possible to obtain quite good ultrasound scans of the
brain, but much greater detail is obtained by an MRI scan.

 Sonography is the imaging method of

choice of ectopic pregnancy.
Knowledge
of
the
sonographic
appearance of these entities is helpful at
arriving at the correct diagnosis. When no
intrauterine pregnancy is visualized,
careful attention to the adnexa is crucial
for finding an extraovarian mass, since
the fallopian tube is the most common
location for ectopic pregnancy.

Why the Test is

Performed
A pregnancy ultrasound may be done during the first
12 weeks of pregnancy to:
Confirm a normal pregnancy
Determine the baby's age
Look for problems, such as ectopic pregnancies or the
chances for a miscarriage
Determine the baby's heart rate
Look for multiple pregnancies (twins, triplets, etc.)
Identify problems of the placenta, uterus, cervix, and
ovaries
Look for findings that might indicate an increased risk for
Down syndrome

 Sonography is used not only to

diagnose ectopic pregnancy but also
to triage patients into the most
appropriate surgical or nonsurgical
management,
to
guide
for
percutaneous treatments of ectopic
pregnancy, and to follow-up patients
when
medical
or
expectant
management protocols are used.

Ectopic Pregnancy
An ectopic pregnancy is a pregnancy that
occurs outside the womb (uterus).It is lifethreatening to the mother.
In most pregnancies, the fertilized egg
travels through the fallopian tube to the
womb (uterus). If the movement of the egg
is blocked or slowed through the tubes, it
can lead to an ectopic pregnancy.
An ectopicpregnancy happens in 1 out of
50 pregnancies

 The most common location of

ectopic
pregnancy
is
in
the
fallopian tube; if an extraovarian
mass is present in a pregnant patient
with pain and bleeding, and no
intrauterine gestational sac is seen,
the diagnosis of ectopic pregnancy
should be considered until proved
otherwise.

 The classic triad of findings in ectopic

pregnancy is pain, bleeding, and an adnexal
mass.
The mother may have early pregnancy symptoms,
such as breast tenderness or nausea. Other
symptoms may include:
Low back pain
Abdominal vaginal bleeding
Mild cramping on one side of the pelvis
No periods
Pain in the lower belly or pelvic area

 The differential diagnosis in a

pregnant patient who presents with
pain and bleeding in the first
trimester includes normal early
pregnancy,
spontaneous
abortion, ectopic pregnancy, and
molar pregnancy.

 The earliest sonographic finding

of an IUP is the intradecidual sign,
which is visualized at about 412
menstrual weeks (eg, 412 weeks after
the LMP.)
Although
the
presence
of
an
intrauterine
gestational
sac
dramatically
decreases
the
likelihood of an ectopic pregnancy.

 Spontaneous abortions are common in

pregnant patients with pain and bleeding
Criteria to diagnose a failed IUP at
sonography should be sufficiently generous
to allow for follow-up of any potential
viable pregnancy but not unnecessarily
This will confirm the presence of an
abnormal IUP if chorionic villi are present
and thereby effectively eliminate the risk
for ectopic pregnancy

 Molar
pregnancy
is
another
possibility in pregnant patients with
pain and bleeding.
The classic findings of an enlarged
uterus with multiple small cysts will
be visualized

 Tubal ectopic pregnancy usually

becomes symptomatic at 56 weeks
after the patients LMP.

 Rare forms of ectopic pregnancy

include
interstitial,
cervical,
abdominal, and scar pregnancies.
2% 4% of all ectopic pregnancies
Interstitial ectopic pregnancy
tends to manifest at 810 weeks
after the LMP

 A cervical ectopic pregnancy is

centered in the cervix, enlarging the
endocervical canal. At times the
gestational sac extends into the
lower uterine segment.

 Scar ectopic pregnancies are being

increasingly reported.
Criteria used for diagnosis of a cesarean
sec- tion scar pregnancy are an empty
uterus,
empty
cervical
canal,
development of the sac in the anterior
part of the lower uterine segment, and
an absence of myometrium between the
bladder wall and the gestational sac.

Conclusion
Sonography plays a central role in
the diagnosis of ectopic pregnancy
If an extraovarian mass is present in
a pregnant patient with pain and
bleeding,
and
no
intrauterine
gestational sac is seen, the diagnosis
of ectopic pregnancy should be
considered until proved otherwise.

THANK YOU