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    Ectopic Pregnancy and Abortion: DR - Shamim Rima MBBS, Dmu, FCGP M.PHL Radiology & Imagimg

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    dr_shamimr
    This document discusses ectopic pregnancy, abortion, and their diagnosis and treatment. It defines ectopic pregnancy as any pregnancy occurring outside the uterine cavity, most commonly in the fallopian tubes. It describes risk factors, signs and symptoms, and diagnostic tests like ultrasound and HCG levels. The document outlines different types of abortion like threatened, incomplete, missed, and details causes like chromosomal abnormalities. It provides images from ultrasounds demonstrating findings of ectopic pregnancies, miscarriages, and blighted ovum.

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    Ectopic Pregnancy and Abortion: DR - Shamim Rima MBBS, Dmu, FCGP M.PHL Radiology & Imagimg

    Uploaded by

    dr_shamimr
    151 views52 pages
    This document discusses ectopic pregnancy, abortion, and their diagnosis and treatment. It defines ectopic pregnancy as any pregnancy occurring outside the uterine cavity, most commonly in the fallopian tubes. It describes risk factors, signs and symptoms, and diagnostic tests like ultrasound and HCG levels. The document outlines different types of abortion like threatened, incomplete, missed, and details causes like chromosomal abnormalities. It provides images from ultrasounds demonstrating findings of ectopic pregnancies, miscarriages, and blighted ovum.

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    Ectopic Pregnancy 1

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    This document discusses ectopic pregnancy, abortion, and their diagnosis and treatment. It defines ectopic pregnancy as any pregnancy occurring outside the uterine cavity, most commonly in the fallopian tubes. It describes risk factors, signs and symptoms, and diagnostic tests like ultrasound and HCG levels. The document outlines different types of abortion like threatened, incomplete, missed, and details causes like chromosomal abnormalities. It provides images from ultrasounds demonstrating findings of ectopic pregnancies, miscarriages, and blighted ovum.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    151 views52 pages

    Ectopic Pregnancy and Abortion: DR - Shamim Rima MBBS, Dmu, FCGP M.PHL Radiology & Imagimg

    Uploaded by

    dr_shamimr
    This document discusses ectopic pregnancy, abortion, and their diagnosis and treatment. It defines ectopic pregnancy as any pregnancy occurring outside the uterine cavity, most commonly in the fallopian tubes. It describes risk factors, signs and symptoms, and diagnostic tests like ultrasound and HCG levels. The document outlines different types of abortion like threatened, incomplete, missed, and details causes like chromosomal abnormalities. It provides images from ultrasounds demonstrating findings of ectopic pregnancies, miscarriages, and blighted ovum.

    Copyright:

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    Download as PPT, PDF, TXT or read online from Scribd
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    The document discusses ectopic pregnancy, which is a pregnancy that occurs outside the uterus. It describes risk factors, signs and symptoms, diagnostic tests and ultrasound features of ectopic pregnancy.

    Risk factors for ectopic pregnancy include previous tubal surgery, previous ectopic pregnancy, pelvic inflammatory disease, endometriosis, previous c-section, assisted reproduction procedures like IVF, and failed contraception.

    The most common presentation of ectopic pregnancy is in a woman of reproductive age experiencing abdominal pain and vaginal bleeding, typically around 7 weeks after her last menstrual period.

    ECTOPIC PREGNANCY

    And
    ABORTION

    DR.SHAMIM RIMA
    MBBS,DMU,FCGP
    M.PHL
    RADIOLOGY & IMAGIMG
    ECTOPIC PREGNANCY

    Any pregnancy that occurs outside of the uterine cavity

     Tubal
     Ampulla (55%)
     Isthmus (25%)
     Fimbria (17%)
     Cervical
     Ovarian
     Abdominal
    GENERAL CONSIDERATIONS

     Risk factors
    - prev. tubal surgery
    - prev. ectopic pregnancy
    - PID, endometriosis
    - prev. c/sec
    - assisted reproduction: GIFT, IVF
    - failed contraception
    SIGN/ SYMPTOM

    Most common presentation:


     Woman of reproductive age

     Abdominal pain

     Vaginal bleeding
     Approx 7 weeks after amenorrhea
    DIAGNOSITC TESTS

    Ultrasound (*test of choice)

    No intrauterine gestational sac

    bHCG

    Do not increase appropriately

    Urine pregnancy test

    Pregnant / not pregnant

    Progesterone level (less reliable)


    SONOGRAPHY SUSPECT ECTOPIC PREGNANCY

     Specific features:
    > Live embryo in the adnexa
     Non-specific features:
    > Empty uterus
    > Pseudo-gestational sac of ectopic pg
    > Adnexal mass
    > Ectopic tubal ring
     Non-supportive features:
    > live intra-uterine pregnancy
    > Intra-decidual & double decidual sign of
    early intra-uterine pg
    > Peritropoblastic blood flow
    LIVE EMBRYO
    LIVE EMBRYO

    TV image: Right adnexal mass / ring gestational sac with yolk sac,
    alive embryo at 7.4 weeksTV image: Embryonic cardiac activity
    depicted in M-mode.
    LIVE EMBRYO

    TV image: Embryonic cardiac activity depicted in M-mode


    LIVE EMBRYO
    LIVE EMBRYO
    EMPTY UTERUS
    Empty Uterus with Ectopic Pregnancy
    PSEUDO-GESTATIONAL SAC OF ECTOPIC PG

    The endometrial sac does not have a surrounding chorionic ring and
    free fluid is visible in the posterior cul-de-sac.
    ADNEXAL MASS
    ADNEXAL MASS

    TA image: uterus containing clot and decidual


    reaction, small amount of fluid cul-de-sac
    ADNEXAL MASS

    TA image: Vague right  adnexal mass


    TUBAL PREGNANCY
    TUBAL PREGNANCY
    OVARIAN PREGNANCY
    OVARIAN PREGNANCY
    OVARIAN PREGNANCY
    ABDOMINAL PREGNANCY
    ECTOPIC TUBAL RING

    Gestational sac surrounded by a thick chorionic ring


    outside and immediately adjacent to the myometrium
    ECTOPIC TUBAL RING
    INTERSTITIAL PREGNANCY

    Gestational sac with a marked eccentric location in the uterus


    CORNUAL PREGNANCY
    PATHOGENESIS OF ECTOPIC PREGNANCIES

     Tubal pregnancy
    - ampullary > isthmic > interstitial
    - secondary, tubo-ovarian, tubo-abdiminal,
    broad-ligament pregnancies develop
    - fertilized ovum burrows through the epithelium
    (because, tube lacks a submocosal layer)
     zygote comes to lie within the muscular wall
     rapidly proliferating trophoblast invades the
    subjacent muscuralis
     maternal blood vessels are opened
    TUBAL RUPTURE

    - the invading, expanding products of conception


    may rupture the oviduct at any sites
    - occur in the first few weeks in first trimester
    (but, interstitial pregnancy usually occur later)
    - usually, spontaneously rupture
    (sometimes coitus or bimanual examination)
    - rarely, undamaged conceptus into the peritoneal

    cavity  lithopedion
    RUPTURE ECTOPIC

    Pelvis- free fluid


    RUPTURE ECTOPIC
    RUPTURE ECTOPIC

    MORISON'S POUCH - FREE FLUID


    Enlarged uterus with
    grossly thickened
    endometrium
    (decidual cast) of
    almost 15 mm. The
    uterus shows
    absence of any
    gestation sac. No
    pseudosac is seen
    Transvaginal scan of
    the pelvis shows a
    large collection of
    hemorrhagic fluid in
    the cul de sac 3) A
    right adnexal mass,
    presumably in the
    Right Fallopian tube
    is also seen. A left
    ovarian hemorrhagic
    cyst is also present.
    HETEROTOPIC GESTATION

    Also called Heterotopic pregnancy or

    simultaneous intrauterine and

    extrauterine pregnancy or coexistent

    intrauterine and extrauterine pregnancy


    HETEROTOPIC GESTATION
    CERVICAL ECTOPIC

    •Implantation of the fertilized ovum with


    subsequent development within the
    cervical structure without involvement
    of the corpus uteri (below the level of
    internal os)
    . In a typical case, the endocervix is
    invaded by the trophoblast, and the
    pregnancy proceeds to develop in the
    fibrous cervical wall. The duration of
    pregnancy is dependent upon the site
    of embryo implantation. The higher it is
    implanted in the cervical canal, the
    greater is its capacity to grow and
    cause haemorrhage .
    CERVICAL ECTOPIC

    Gestational sac in cervico- isthmic region


    CERVICAL ECTOPIC

    Transvaginal Ultrasound showing 10 week cervical ectopic gestation


    CERVICAL ECTOPIC
    CERVICAL ECTOPIC
    ABORTION
    ABORTION

    Spontaneous Abortion
    Pregnancy loss at less than 20 weeks’ gestation

    Threatened abortion

    A pregnancy complicated by bleeding before 20 weeks’


    gestation
    Inevitable abortion

    The cervix has dilated, but the products of conception have not
    been expelled

    Complete abortion

    All products of conception have been passed without need for surgical
    or medical intervention
    ABORTION
    Incomplete abortion

    Some, but not all, of the products of conception have been passed;
    retained products may be part of the fetus, placenta, or membranes

    Missed abortion

    A pregnancy in which there is a fetal demise (usually for a number


    of weeks) but no uterine activity to expel the products of conception

    Septic abortion

    A spontaneous abortion that is complicated by intrauterine infection

    Recurrent spontaneous abortion

    Three (3) or more consecutive pregnancy losses


    CAUSES

    First Trimester Miscarriages


    Chromosomal abnormalities
    Second Trimester Miscarriages
    Structural Problems
    Cavity defects:
    uterine fibroids
    a septum
    scar tissue
    possibly a large polyp
    Cervical insufficiency (also termed cervical incompetence)
    Thrombosis
    Infection
    Genetic or Chromosomal Problems in the Fetus
    RISK FACTORS

    Increasing maternal age


    9% for a 20-24 year-old
    15% for a 30-34 year-old
     51% for a 40-44 year-old
    Advancing age of the father 
    Smoking, alcohol, cocaine and heavy coffee consumption
    Certain drugs, such as those used for chemotherapy
    Certain medical conditions are risk factors as well. These include:
    Poorly-controlled diabetes
    Uncontrolled thyroid disease
    High prolactin (a hormone associated with breastfeeding) levels
    The polycystic ovarian syndrome.
    Obesity or severely low weight.
    COMPLETE MISCARRIAGE
    COMPLETE MISCARRIAGE

    The absence of the gestational sac and the presence of intrauterine debris
    INCOMPLETE ABORTION

    Empty gestational sac. 


    MISSED
    MISSEDABORTION
    ABORTION

    In a missed abortion, falling levels of HCG or ultrasound


    imaging confirm that a miscarriage has occurred, but minimal
    or no bleeding occurs and the uterus has failed to expel the
    pregnancy. 
    MISSED
    MISSEDABORTION
    ABORTION

    Missed abortion 9Wks GA by 2D ultrasound and by using color flow


    mapping to detect absence of color signals from fetal heart. The
    spectral Doppler shows an artifact from maternal arterial “thump”. 
    BLIGHTED OVUM

    The gestational sac is irregularly formed, and also the embryo


    is missing from inside the gestational sac (Blighted Ovum)

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