And
ABORTION
DR.SHAMIM RIMA
MBBS,DMU,FCGP
M.PHL, THESIS PART
RADIOLOGY & IMAGIMG
ECTOPIC PREGNANCY
Tubal
Ampulla (55%)
Isthmus (25%)
Fimbria (17%)
Cervical
Ovarian
Abdominal
GENERAL CONSIDERATIONS
Risk factors
- prev. tubal surgery
- prev. ectopic pregnancy
- PID, endometriosis
- prev. c/sec
- assisted reproduction: GIFT, IVF
- failed contraception
SIGN/ SYMPTOM
Abdominal pain
Vaginal bleeding
Approx 7 weeks after amenorrhea
DIAGNOSITC TESTS
bHCG
Specific features:
> Live embryo in the adnexa
Non-specific features:
> Empty uterus
> Pseudo-gestational sac of ectopic pg
> Adnexal mass
> Ectopic tubal ring
Non-supportive features:
> live intra-uterine pregnancy
> Intra-decidual & double decidual sign of
early intra-uterine pg
> Peritropoblastic blood flow
LIVE EMBRYO
TV image: Right adnexal mass / ring gestational sac with yolk sac,
alive embryo at 7.4 weeksTV image: Embryonic cardiac activity
depicted in M-mode.
TV image: Embryonic cardiac activity depicted in M-mode
EMPTY UTERUS
Empty Uterus with Ectopic Pregnancy
PSEUDO-GESTATIONAL SAC OF ECTOPIC PG
The endometrial sac does not have a surrounding chorionic ring and
free fluid is visible in the posterior cul-de-sac.
ADNEXAL MASS
TA image: uterus containing clot and decidual reaction, sm
all amount of fluid cul-de-sac
TA image: Vague right adnexal mass
TUBAL PREGNANCY
TUBAL PREGNANCY
OVARIAN PREGNANCY
ABDOMINAL PREGNANCY
Sagittal transvaginal image shows the fetal head (h)
in the cul-de-sac, posterior to the uterus (U)
CESAREAN SCAR ECTOPIC PREGNANCY
ECTOPIC TUBAL RING
Tubal pregnancy
- ampullary > isthmic > interstitial
- secondary, tubo-ovarian, tubo-abdiminal,
broad-ligament pregnancies develop
- fertilized ovum burrows through the epith
elium
(because, tube lacks a submocosal la
yer)
zygote comes to lie within the muscula
r wall
rapidly proliferating trophoblast invade
s the
subjacent muscuralis
maternal blood vessels are opened
TUBAL RUPTURE
pregnancy
CERVICAL ECTOPIC
Spontaneous Abortion
Pregnancy loss at less than 20 weeks’ gestation
Threatened abortion
The cervix has dilated, but the products of conception have not
been expelled
Complete abortion
All products of conception have been passed without need for surgical
or medical intervention
ABORTION
Incomplete abortion
Some, but not all, of the products of conception have been passed;
retained products may be part of the fetus, placenta, or membranes
Missed abortion
Septic abortion
The gestational sac is irregularly formed, and also the embryo is missing
from inside the gestational sac (Blighted Ovum)
Missed abortion 9Wks GA by 2D ultrasound and by using color flow
mapping to detect absence of color signals from fetal heart. The
spectral Doppler shows an artifact from maternal arterial “thump”.