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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 14  |  Issue : 4  |  Page : 436-437

Live ectopic pregnancy: Ultrasound and color doppler imaging


1 Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, DMIMS, Wardha, Maharashtra, India
2 Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Submission10-Jan-2020
Date of Decision15-Jan-2020
Date of Acceptance22-Jan-2020
Date of Web Publication16-Jul-2020

Correspondence Address:
Dr. Suresh Phatak
Department of Radio-Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_31_20

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How to cite this article:
Jain S, Phatak S. Live ectopic pregnancy: Ultrasound and color doppler imaging. J Datta Meghe Inst Med Sci Univ 2019;14:436-7

How to cite this URL:
Jain S, Phatak S. Live ectopic pregnancy: Ultrasound and color doppler imaging. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Aug 11];14:436-7. Available from: http://www.journaldmims.com/text.asp?2019/14/4/436/289856



Sir,

Ectopic pregnancies represent a major health risk for women of childbearing age and can result in life-threatening complications if not treated properly. The classic clinical triad of ectopic pregnancy is pain, amenorrhea, and vaginal bleeding.[1] Initial evaluation of ectopic pregnancy consists of hormonal assays and pelvic ultrasonography. Its most common location is  Fallopian tube More Details.[2]

An ectopic pregnancy is known to occur when a blastocyst gets implanted in a location other than the endometrial lining of the uterine cavity. This theory stands true for both singleton and multigestational ectopic pregnancies.[1] The exact etiology of ectopic pregnancy is unknown. Combination of arrest of the embryo in the Fallopian tube and changes in the tubal microenvironment that allow early implantation to occur can be one of the causes.[3] Infection or smoking can lead to inflammation of the fallopian tube, which may disrupt smooth muscle contractility and ciliary activity, affecting the embryo-tubal transport, and hence can also provide pro-implantation signals.[4]

The key to diagnosis of an ectopic pregnancy is determining the presence or absence of an intrauterine gestational sac with correlation of serum β-hCG levels. An adnexal mass that is separate from the ovary and the tubal ring sign which is also referred to as bagel sign or blob sign is the most common finding of a tubal pregnancy.[2] It is echogenic ring formed surrounding an unruptured ectopic pregnancy.[3] Adnexal masses are graded sonographically. Grade I is nonspecific adnexal mass, Grade II is when there is a tubal ring, Grade III means the presence of yolk sac, and Grade IV is the presence of an embryo with cardiac activity.[5],[6],[7],[8],[9],[10],[11] Fluid in the pouch of Douglas, free fluid in the pelvis, and/or a pseudosac in the endometrial cavity are some of the other indirect signs, which are helpful in establishing the diagnosis. Some other presentations could be an in-homogenous adnexal mass or an empty extrauterine sac with an empty endometrial cavity. Ectopic pregnancy can also occur in the cervical region or along the lower anterior segment of the uterine wall with myometrial dehiscence in a cesarean section scar but is very rare [Figure 1], [Figure 2].[1]
Figure 1: Transabdominal ultrasound and color Doppler image showing fluid present in the uterine cavity known as the pseudogestational sac, a gestational sac posterior to the bladder with live embryo of approximately 7 weeks showing cardiac activity (grade IV), color signals seen on Doppler in the fetal heart

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Figure 2: Transabdominal ultrasound image showing free fluid with some internal debris within the Morrison's pouch suggestive of hemoperitoneum

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vohra S, Mahsood S, Shelton H, Zaedi K, Economides DL. Spontaneous live unilateral twin ectopic pregnancy – A case presentation. Ultrasound 2014;22:243-6.  Back to cited text no. 1
    
2.
Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics 2008;28:1661-71.  Back to cited text no. 2
    
3.
Nadim B, Infante F, Lu C, Sathasivam N, Condous G. Morphological ultrasound types known as 'blob'and 'bagel'signs should be reclassified from suggesting probable to indicating definite tubal ectopic pregnancy. Ultrasound Obstet Gynecol 2018;51:543-9.  Back to cited text no. 3
    
4.
Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care 2011;37:231-40.  Back to cited text no. 4
    
5.
Frates MC, Doubilet PM, Peters HE, Benson CB. Adnexal sonographic findings in ectopic pregnancy and their correlation with tubal rupture and human chorionic gonadotropin levels. J Ultrasound Med 2014;33:697-703.  Back to cited text no. 5
    
6.
Phatak S, Shrivastav D, Marfani G, Daga S, Madurwar K, Samad S. Transvaginal Sonography and Elastography Evaluation of Ectopic Pregnancy. J Datta Meghe Inst Med Sci Univ 2019;14:86-9. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_13_19. [Last accessed on 2019 Oct 2019].  Back to cited text no. 6
    
7.
Bhriegu R, Agrawal M, Hariharan C. Assessment of Maternal and Perinatal Outcome in Postdated Pregnancy. J Datta Meghe Inst Med Sci Univ 2017;12:35-40. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_20_17. [Last accessed on 2019 Oct 2019].  Back to cited text no. 7
    
8.
Roy M, Gajbe UL, Singh BR, Thute P. Morphometric Measurement of Fetal Femur Length for the Prediction of Gestational Age in the Ii Nd and Iii Rd Trimester of Pregnancy by Ultrasonography. J Datta Meghe Inst Med Sci Univ 2017;12:187-90. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_71_17. [Last accessed on 2019 Oct 2019].  Back to cited text no. 8
    
9.
Harshika S, Agrawal M, Bhake A, Gupta N. Colour doppler evaluation in high-risk pregnancy and perinatal outcome. J Evol Med Dent Sci 2018;7:4603-8. Available from: https://doi.org/10.14260/jemds/2018/1027. [Last accessed on 2019 Oct 2019].  Back to cited text no. 9
    
10.
Singhania S, Singhania A, Khan S, Kumar V, Singhania P. Prenatal Diagnosis of Cross-Fused Renal Ectopia: Still a Dilemma. Donald Sch J Ultrasound Obstet Gynecol 2017;11:225-6. Available from: https://doi.org/10.5005/jp-journals-10009_1526. [Last accessed on 2019 Oct 2019].  Back to cited text no. 10
    
11.
Kumar V, Sharma G, Khan S, Singhania A, Singhania S. Study of the Significance of Fetal Doppler Flow Velocimetry in the Perinatal Outcome of Growth-Restricted Fetuses. Int J Infect Fetal Med 2017;8: 83-8. Available from: https://doi.org/10.5005/jp-journals-10016-1153. [Last accessed on 2019 Oct 2019].  Back to cited text no. 11
    


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