Role of 3 d ultrasound in ectopic pregnancy

1. Role of 3D ultrasound in ectopic pregnancy. Catch me if u scan . Dr. Omneya Nagy Elmakhzangy Special Fetal Care Unit Ain Shams University

2. Ectopic pregnancies in a Caesarean scar Implantation of a pregnancy within a Caesarean fibrous tissue scar is considered to be the rarest form of ectopic pregnancy and a life-threatening condition. Since the clinical diagnosis of an early pregnancy implanted in a previous Caesarean scar can be very difficult, it may occasionally be delayed until the uterus ruptures and the patient experiences life threatening bleeding (Seow et al., 2000, 2004; Weimin and Wenqing, 2002; Yang and Jeng, 2003; Maymon et al., 2004)

3. Diagnosis should be based on the pregnant patients history and her clinical manifestations, such as abdominal pain and any amount of bleeding (ranging from spotting to a lifethreatening haemorrhage). The most important investigation, however, is based on sonographic and Doppler flow findings (Marchiole et al., 2004). Generally, sonography can detect an enlargement of the Caesarean scar in the lower segment and a mixed mass or a clear gestational sac that is attached to it. A very thin myometrium in a state of pre-rupture can occasionally be visualized inbetween the bladder wall and the gestational scar (Weimin and Wenqing, 2002,2000, 2004; Fylstra, 2002)).

4. a discontinuity in the anterior wall of the uterus being demonstrated on a sagittal view of the uterus when the direction of the ultrasound beam runs through the amniotic sac (Vial et al., 2000) This criterion assists in distinguishing this type of pregnancy from other diagnostic options, such as cervicoisthmic implantation, cervical pregnancy and spontaneous abortion in progress (Godin et al., 1997; Fylstra, 2002)

5. Others (Shih, 2004) used 3-dimensional (3D) ultrasound and 3D Power Doppler. According to their experience, using the combination of the multiplanar views and 3D-rendered images permits more accurate diagnosis in the same situation. The peritrophoblastic flow surrounding the trophoblastic shell may be further illustrated by 3D Power Doppler ultrasound to ascertain the diagnosis (Shih, 2004)

6. Interstitial pregnancy Interstitial ectopic pregnancy is defined as the ectopic gestation developing in the uterine part of the fallopian tube. It is a rare event constituting only 5% of all tubal ectopic pregnancies and is associated with a high rate of complications (Wood C, et al. 1992). Interstitial ectopic pregnancy is associated with a higher risk of shock and hemoperitoneum than other forms of ectopic pregnancy, as well as with a higher risk of maternal mortality due to delayed diagnosis and high vascularity of the myometrium. The condition is difficult to diagnose, both clinically and sonographically

7. The presence of an eccentrically located gestation sac with incomplete or asymmetric myometrial tissue, < 5 mm in thickness, is a highly suggestive but nonspecific indicator of interstitial pregnancy. The 3D scans are very useful in obtaining the coronal scans of the fundal region of the uterus, giving a better overview of the cornual regions of the uterus. The characteristic features of an interstitial ectopic pregnancy include a GS located eccentrically outside the endometrial cavity of the uterus, in the region of the fundus with no or minimal identifiable myometrial tissue on its lateral aspect. This eccentric location and superior and lateral myometrial stripes are better and easily visualized on coronal scans generated through 3D TVS, an infrequent achievement with 2D scans.

8. Three-dimensional sonographic diagnosis of ovarian pregnancy Among ectopic pregnancies, ovarian ones are extremely rare. Sonographic diagnosis is feasible although differential diagnosis from the more common tubal location is difficult. (Ghi-et al , 2005) Owing to their similar sonographic appearance, even distinction from an ipsilateral corpus luteum is not straightforward.(Ghi-et al , 2005) Among the risk factors for ovarian pregnancy, endometriosis or intrauterine device usage have been commonly described (Riethmuller D. et al,1996)

9. Three-dimensional volume ultrasound of the left ovary: a small mass compatible with bagel appearance bulging from the cortex and co-existing with two additional masses is noted. CL, corpus luteum; ES, ectopic sac. Appearance of left ovary at laparoscopy; a small bleeding bulge on the ovarian surface compatible with a gestational sac is noted. Copyright 2005 ISUOG

Role of 3 d ultrasound in ectopic pregnancy

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