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.


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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


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Uterus

5193474

Transvaginal Ultrasound


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Cervix

Transvaginal Ultrasound


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Right Adnexa

Transvaginal Ultrasound


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Right Ovary

Transvaginal Ultrasound


Slide 14

Right Ovary

Transvaginal Ultrasound


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Left Adnexa

Transvaginal Ultrasound


Slide 16

Left Adnexa

Transvaginal Ultrasound


Slide 17

Left Adnexa

Transvaginal Ultrasound


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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

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