Ultrasonography in ectopic pregnancies.

USG findings in ectopic pregnancy
Types of ectopic pregnancy

1. ECTOPIC PREGNANCY Dr.Gayathiri 1 st year PG OBG

2. ECTOPIC PREGNANCY Pregnancy implanting outside the endometrial cavity Incidence 1 – 2 % Risk factors : PID , prior EP , Tubal surgery IVF , smoking, vaginal douching, ↑ maternal age, and endometriosis.

3. Fallopian tube – 95% Ampulla – 70% Isthmus – 12 % Fimbrial – 11 % Interstitium – 2 % Nontubal – 5% Ovarian 0.5 – 1 % Cervical - < 1% Scar site Abdominal

4. Classic triad of symptoms (minority of cases) Pain Abnormal vaginal bleeding palpable adnexal mass β HCG USG Empty uterine cavity Pseudogestational sac Decidual cast Thick ecogenic endometrium Tubal ring sign Ring of fire sign

5. Heterotopic pregnancy Coexisting extrauterine pregnancy 1:10,000 to 1:50,000 ART higher incidence

6. Interstitial ectopic pregnancy

7. CESAREAN SCAR PREGNANCY The criteria for diagnosis of a CSEP (1) empty uterine cavity (2) Empty cervical canal (3)GS at anterior wall of lower uterus with thin or absent myometrium between sac and anterior border of uterus (4) C olor Doppler with trophoblastic blood flow around the GS ( 5) Trophoblastic flow at the Cesarean scar and a positive pregnancy test

8. DIFFERENTIALS IUP at cervicoisthmic junction ( center of Gsac proximal to midpoint of cervix and fundus ) Expelling abortus ( avascular ) Negative Sliding sign – gentle pressure applies to cervix by vaginal probe will fail to move an implanted gestation.

9. CERVICAL ECTOPIC PREGNANCY Implantation proximal or below the internal os < 0.1% of all ectopic Pregnancies