Ectopic Pregnancy February, 2013 Susana Smith Harbutt Dr. Joy Sclamberg Clinical History and Physical Exam HPI: The patient is a 36 year old G10P6030
Download ReportTranscript Ectopic Pregnancy February, 2013 Susana Smith Harbutt Dr. Joy Sclamberg Clinical History and Physical Exam HPI: The patient is a 36 year old G10P6030
Slide 1
Ectopic Pregnancy
February, 2013
Susana Smith Harbutt
Dr. Joy Sclamberg
Slide 2
Clinical History and Physical Exam
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
2
Slide 3
Working Diagnosis
• 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
Slide 4
Beta HCG
Discriminatory HCG: level at which an intrauterine pregnancy should be
detected by ultrasound. If not present than abnormal or ectopic gestation is
likely.
Slide 5
Diagnostic Imaging Options
• Ultrasound
• MRI
• CT
Slide 6
ACR Criteria
Slide 7
Ultrasound
Slide 8
Normal Pregnancy
• Double Decidua Sign
Slide 9
Normal Pregnancy
Yolk Sac at 5 weeks
Yolk Sac and Embryo
Slide 10
Uterus
5193474
Transvaginal Ultrasound
Slide 11
Cervix
Transvaginal Ultrasound
Slide 12
Right Adnexa
Transvaginal Ultrasound
Slide 13
Right Ovary
Transvaginal Ultrasound
Slide 14
Right Ovary
Transvaginal Ultrasound
Slide 15
Left Adnexa
Transvaginal Ultrasound
Slide 16
Left Adnexa
Transvaginal Ultrasound
Slide 17
Left Adnexa
Transvaginal Ultrasound
Slide 18
Gestational Sac
Transvaginal Ultrasound
Slide 19
Gestational Sac
Transvaginal Ultrasound
Slide 20
Yolk Sac
Transvaginal Ultrasound
Slide 21
Embryo – Fetal Pole
Transvaginal Ultrasound
Slide 22
Left Adnexa
Transvaginal Ultrasound
Slide 23
“Ring of Fire”
Transvaginal Doppler Ultrasound
Slide 24
Treatment
Operative laparoscopy with removal of ectopic pregnancy and salpingectomy
Pathology Report:
Slide 25
Case and References
MRN: 9003501
Accession: 5193474
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:
10.1056/NEJMcp0810384
Levine, Deborah. Ectopic Pregnancy. Radiology. 2007.245: 385-397
25
Ectopic Pregnancy
February, 2013
Susana Smith Harbutt
Dr. Joy Sclamberg
Slide 2
Clinical History and Physical Exam
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
2
Slide 3
Working Diagnosis
• 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
Slide 4
Beta HCG
Discriminatory HCG: level at which an intrauterine pregnancy should be
detected by ultrasound. If not present than abnormal or ectopic gestation is
likely.
Slide 5
Diagnostic Imaging Options
• Ultrasound
• MRI
• CT
Slide 6
ACR Criteria
Slide 7
Ultrasound
Slide 8
Normal Pregnancy
• Double Decidua Sign
Slide 9
Normal Pregnancy
Yolk Sac at 5 weeks
Yolk Sac and Embryo
Slide 10
Uterus
5193474
Transvaginal Ultrasound
Slide 11
Cervix
Transvaginal Ultrasound
Slide 12
Right Adnexa
Transvaginal Ultrasound
Slide 13
Right Ovary
Transvaginal Ultrasound
Slide 14
Right Ovary
Transvaginal Ultrasound
Slide 15
Left Adnexa
Transvaginal Ultrasound
Slide 16
Left Adnexa
Transvaginal Ultrasound
Slide 17
Left Adnexa
Transvaginal Ultrasound
Slide 18
Gestational Sac
Transvaginal Ultrasound
Slide 19
Gestational Sac
Transvaginal Ultrasound
Slide 20
Yolk Sac
Transvaginal Ultrasound
Slide 21
Embryo – Fetal Pole
Transvaginal Ultrasound
Slide 22
Left Adnexa
Transvaginal Ultrasound
Slide 23
“Ring of Fire”
Transvaginal Doppler Ultrasound
Slide 24
Treatment
Operative laparoscopy with removal of ectopic pregnancy and salpingectomy
Pathology Report:
Slide 25
Case and References
MRN: 9003501
Accession: 5193474
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:
10.1056/NEJMcp0810384
Levine, Deborah. Ectopic Pregnancy. Radiology. 2007.245: 385-397
25