The many faces of ectopic pregnancies: demystifying the common and less common entities
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The many faces of ectopic pregnancies: demystifying the common and less common entities F. Eymen Ucisik‑Keser1 · Eduardo J. Matta1 · Miguel G. Fabrega1 · Chitra Chandrasekhar1 · Steven S. Chua1 Received: 30 April 2020 / Revised: 16 July 2020 / Accepted: 21 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Ectopic pregnancy is a major cause of 1st trimester pregnancy deaths. It occurs in various locations in the abdominopelvic cavity. Ultrasonography is a first-line, rapid, and noninvasive modality for ectopic pregnancy evaluation. MRI can help clarify equivocal cases. When in doubt about the location, one should give an intrauterine pregnancy the benefit of the doubt with close ultrasound and hCG follow-up. Here, we will review the imaging findings and mimickers of ectopic pregnancies. Graphic Abstract
Keywords Ultrasound · MRI · Ectopic pregnancy · Pregnancy of unknown location · Molar Pregnancy
Introduction * F. Eymen Ucisik‑Keser [email protected] Eduardo J. Matta [email protected] Miguel G. Fabrega [email protected] Chitra Chandrasekhar [email protected] Steven S. Chua [email protected] 1
Department of Diagnostic and Interventional Radiology, University of Texas McGovern Medical School, 6431 Fannin St, MSB 2.130B, Houston, TX 77030, USA
Ectopic pregnancy (EP) occurs with abnormal blastocyst implantation in a site other than the endometrium. EPs comprise 1.4% of all pregnancies, and are the leading cause of hemorrhage-related pregnancy deaths [1–3]. Predisposing factors include prior EP, pelvic inflammatory disease, tubal surgery, Caesarian section, fertility treatment, intrauterine devices, endometriosis, smoking, and variant reproductive system anatomy. However, half of the women with EP do not have any known risk factors [4]. Uncomplicated EP may be asymptomatic and incidentally detected with routine early pregnancy ultrasonography. In the emergency room setting, the classic scenario is
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a female patient of reproductive age complaining of lower abdominal pain with a positive urine pregnancy test, and possibly vaginal bleeding [5]. In early pregnancy, determination of the pregnancy site may be an ultrasonographic challenge due to the small size and nonspecific appearance of the gestational sac, as well as various mimickers of early intrauterine pregnancies (IUPs) and EPs. In very early IUP with serum hCG levels below the discriminatory zone of 1500–2000 mIU/mL [6, 7], a sac may not be identified at all. Furthermore, the presence of an IUP does not rule out an EP. Therefore, a meticulous search for a possible EP should be part of every ultrasound examination of early pregnancy. Pelvic ultrasonography is the first-line modality for the detection of EPs and its complications. Therefore, it plays a vital role in management decisions (expectant vs. medical vs. surgical) and their timing (emergent vs. nonemergent). The standard protocol involves a transabdominal portion follo
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