<\/p>\n
<\/p>\n
OB\/Gyn Ultrasound<\/p>\n
Urine test for B-hCG has a threshold of 20 IU\/L and should detect a pregnancy 1 week post-contraception (3 weeks gestational age)<\/p>\n
<\/p>\n
Progesterone for further evaluation\u00a0 >11ng\/ml is assoc with intrauterine pregnancy (sens 91, spec 84)\u00a0 Acad Emerg Med 1998:5, 309)<\/p>\n
<\/p>\n
2% of pregnancies are ectopics, however, symptomatic pts presenting to the emergency department can have rates from 7.5%-13%.<\/p>\n
<\/p>\n
Discriminatory zones for serum B-hCG differ by institution but are usually between 1000-1500.<\/p>\n
<\/p>\n
Vaginal Bleeding or threatened AB occurs in 25% of all clinically apparent early pregnancies.\u00a0 40-50% will end in loss of the pregnancy.<\/p>\n
<\/p>\n
Spontaneous AB is the expulsion of a non-viable pregnancy before 20 weeks.\u00a0 Microscopic presence of chorionic villi or obvious products of conception are necessary to make this diagnosis.<\/p>\n
<\/p>\n
Incomplete AB is term for a failed pregnancy in which not all of the products have been expelled.<\/p>\n
Uterus in non-gravid state is 6-7 cm long and 3-4 cm in transverse and AP.\u00a0 Located in the center of the true pelvis between bladder and rectosigmoid colon.\u00a0 An anteflexed uterus forms a 90\u00b0 angle with the vaginal canal.\u00a0 The anterior cul-de-sac lies between the uterus and the bladder and is usually empty or filled with bowel.\u00a0 The posterior cul-de-sac or the Pouch of Douglas, is usually filled with bowel loops.\u00a0 It is the most dependant portion of the intraperitoneal region and therefore the most common site for free pelvic fluid.<\/p>\n
<\/p>\n
TRANSABDOMINAL IMAGING ALWAYS PRECEDES Transvaginal<\/p>\n
<\/p>\n
Should be performed with a full bladder.\u00a0 The absence of this sonographic window can be overcome in thin women with firm pressure.<\/p>\n
Midline sagittal views are the most useful.\u00a0 Scan right above the pubic bone with the marker towards the patient\u0092s head.<\/p>\n
Empty Bladder<\/p>\n
Should see entire midline stripe.\u00a0 If the uterus is not immediately seen, it may be anteverted and the probe should be aimed upwards towards the anterior abdominal wall.\u00a0 The uterus will appear as a relatively hypoechoic structure with thick walls and a well defined border.\u00a0 The endometrial midline stripe is thin during the preovulatory phase and thickens and becomes more echogenic during the secretory phase.\u00a0 The cervix can be examined by pulling the probe back a few cm and aiming the head of the probe towards the patient\u0092s back.\u00a0 The ovaries lie just lateral and posterior to the body of the uterus.<\/p>\n
<\/p>\n
Ovaries hypoechoic structures containing multiple anoechoic follicles.\u00a0 Internal iliac artery and external iliac vein<\/p>\n
<\/p>\n
Transvaginal coronal.\u00a0 If structures are not easily visualized, press on the patient\u0092s anterior abdominal wall to bring them close to the probe tip.\u00a0 If structure might be bowel, stay still and watch for peristalsis to confirm.<\/p>\n
Weeks<\/strong><\/p>\n Beta<\/strong><\/p>\n Vag Probe<\/strong><\/p>\n Abd Probe<\/strong><\/p>\n 4-5<\/p>\n <1000<\/p>\n Intradecidual Sac (\u00b1DDS)<\/p>\n <\/p>\n 5<\/p>\n 1000-2000<\/p>\n Gestational Sac (\u00b1DDS)<\/p>\n <\/p>\n 5-6<\/p>\n >2000<\/p>\n Yolk Sac<\/p>\n Gestational Sac (\u00b1DDS)<\/p>\n 6<\/p>\n 10-20000<\/p>\n Heart Tones<\/p>\n Yolk Sac<\/p>\n 7<\/p>\n >20000<\/p>\n Clear Embryo<\/p>\n Embryo<\/p>\n <\/p>\n Small sac completely embedded in the endometrium on one side of the uterine midline, not deforming the midline stripe.\u00a0 There should be focal echogenic thickening around the sac<\/p>\n <\/p>\n Sonolucent center, thick echogenic ring.<\/p>\n DDS:\u00a0 double-decidual sign.\u00a0 2 echogenic rings surrounding the sac.\u00a0 Decidua capsularis and decidua vera.\u00a0 Makes IUP very likely, but not 100% sensitive (AJR 1996:167)\u00a0 It is normal to sometimes not be able to visualize the double rings the full circumference of the sac.<\/p>\n Must have at least 5mm of myometrium surrounding the entire sac in both sag and transverse<\/p>\n The first definitive sign of an IUP.\u00a0 Symmetric circular echogenic structure at the edge of the sac.\u00a0 Present from 5-12 weeks of gestational age.\u00a0 Should see the yolk sac if the gestational sac is >1 cm.\u00a0 If the gestational sac is >2 cm and empty, then it is indicative of fetal demise.<\/p>\n Cardiac activity should be seen with an embryo>5mm, at >6 weeks, or >10000 B-hCG.\u00a0 Examine with M-Mode, not Doppler.<\/p>\n Most accurate test to establish dates.\u00a0 Do not measure the yolk sac.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 More than 40% of ectopics present with B-hCG of <1000.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The only clinical evidence of spontaneous abortion is the passage of products of conception or chorionic villi.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Always consider heterotopics in women on fertility meds or those having undergone in vitro fertilization.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Do FAST Exam if woman is unstable<\/p>\n Live embryo outside of the uterus<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Free fluid in the posterior cul de sac<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Empty uterus with beta above discriminatory zone<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tubal ring-looks like a small gestational sac outside of the uterus.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Complex mass-cystic and solid components<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Interstitial ectopics can look just like IUPs, only careful scanning will reveal that it lies on the margin of the uterine wall and not in the intrauterine cavity, (2-5% of ectopics)<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gestational sac>1 cm without yolk sac is probable, >2 cm is definite.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Embryos >5 mm should have cardiac activity<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Gestational Sac low in uterus<\/p>\n Corpus Luteum Cyst-<\/p>\n Leiomyomas<\/p>\n Finding a normal ovary makes this diagnosis less likely<\/p>\n Cluster of grapes appearance, an intrauterine mass with diffuse hypoechoic vesicles.<\/p>\n <\/p>\n Tubo-ovarian abscess<\/p>\n <\/p>\n <\/p>\n |\u00a0\u00a0 \u00a0\u00a0 |\u00a0\u00a0 \u00a0\u00a0 |<\/p>\n","protected":false},"excerpt":{"rendered":" Array<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[16],"tags":[],"yoast_head":"\nIntradecidual Sac<\/h4>\n
Gestational Sac<\/h4>\n
<\/h4>\n
Yolk Sac<\/h4>\n
<\/h4>\n
Fetal Heart Tones<\/h4>\n
<\/h4>\n
Crown Rump Length<\/h4>\n
<\/h3>\n
<\/span>Ectopics<\/span><\/h3>\n
<\/h4>\n
Definite<\/h4>\n
<\/h4>\n
Nonspecific<\/h4>\n
<\/h4>\n
Pregnancy Loss<\/h4>\n
<\/h3>\n
<\/span>Variants<\/span><\/h3>\n
Pelvic Masses<\/h4>\n
<\/h4>\n
Adnexal Torsion<\/h4>\n
<\/h4>\n
Gestational Trophoblastic Disease<\/h4>\n