JOURNAL READING Ectopic Pregnancy

JOURNAL READING

Ectopic PregnancyPreceptor :dr. Munir, Sp. Rad

Student :Andrew Lienata 07120110066

Kepaniteraan Ilmu RadiologiFakultas Kedokteran Universitas Pelita HarapanRS Bhayangkara Tingkat I Raden Said Sukanto

UltrasonographyDiagnostic 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 techniquesUltrasound 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.Ultrasound is particularly suited to imaging soft tissues such as the eye, heart and other internal organs, and examining blood vessels.Disadvantages of ultrasound compared with other techniquesThe major disadvantage is that the resolution of images is often limited. This is being overcome as timepasses, but there are still many situations where X-rays 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 PerformedA pregnancy ultrasound may be done during the first 12 weeks of pregnancy to:

Confirm a normal pregnancyDetermine the baby's ageLook for problems, such as ectopic pregnancies or the chances for a miscarriageDetermine the baby's heart rateLook for multiple pregnancies (twins, triplets, etc.)Identify problems of the placenta, uterus, cervix, and ovariesLook for findings that might indicate an increased risk for Down syndromeSonography 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 PregnancyAn ectopic pregnancy is a pregnancy that occurs outside the womb (uterus).It is life-threatening 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 pregnanciesThe 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 painAbdominal vaginal bleedingMild cramping on one side of the pelvisNo periodsPain 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.

ConclusionSonography 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.

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