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Should a clinical presentation or abnormal pelvic ultrasound appearance suggest an ectopic pregnancy, despite visualization of an intrauterine gestation, the diagnosis of heterotopic pregnancy should be considered, with the probable need for diagnostic laparoscopy confirmation and treatment.].
This exponential rise is less reliable after 10,000 m IU/ml, and at this level, pregnancy is better evaluated with ultrasound.
The disadvantages of performing this examination routinely are related to cost, errors in diagnosing ectopic pregnancies that in fact are intrauterine, increased training requirements for providers, and potential biologic hazards to the fetus that are presently unknown.
The natural history of such a condition is unknown, but uterine scar rupture and hemorrhage, even in the first trimester, seems likely if the pregnancy is allowed to continue, with possible serious maternal morbidity and the possible need for hysterectomy and loss of subsequent fertility.
Early diagnosis of such implantation is made only with a high level of suspicion: early ultrasound in a woman with a prior cesarean delivery (Fig.
), and embryonic cardiac motion can be first observed 3 1/2 to 4 weeks post-conception (5 1/2–6 weeks after last menstrual period).
When exact pregnancy dating is available, an intrauterine pregnancy, regardless of embryonic number, should be identified within the endometrial cavity with transvaginal ultrasonography by 24 embryonic days or 38 menstrual days (exact 28 day menstrual cycle).
However, when an adnexal ectopic is diagnosed with a nonsurgical algorithm, conservative medical therapy can be successful without a true diagnosis of location.].
True primary abdominal implantation must satisfy the criteria of Studdiford.
Usually, the first complaint is painless vaginal bleeding and speculum examination may reveal an open external cervical os with a fleshy-type endocervical mass presenting.
With early transvaginal ultrasound, these implantations are easily identified (Fig.
Rankin suggested that the diagnosis by ultrasound examination of cervical pregnancy required 4 criteria: enlargement of the cervix, uterine enlargement, diffuse amorphous intrauterine echoes, and absence of an intrauterine pregnancy . refined the criteria to include the placenta and entire chorionic sac containing the pregnancy must be below the internal cervical os and the cervical canal must be dilated and barrel shape [If necessary to exclude the diagnosis of a spontaneous abortion in progress, the presence of embryonic cardiac activity and/or Doppler ultrasound indicating vascular attachment confirms a living pregnancy.].
Ovarian pregnancy like other non-tubal ectopic pregnancies may occur without the usual expected antecedent risk factors for ectopic pregnancy but does seem to have a strong association with conceptions with an intrauterine contraceptive device in place [It is difficult to preoperatively make the diagnosis of ovarian pregnancy.
Failure to follow basic ultrasound principles can miss the diagnosis.Tags: Adult Dating, affair dating, sex dating