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IMAGING IN OBSTETRIC EMERGENCIES
BY
DR.S.PRADEEP.MD,DNB,RD.
CONSULTANT RADIOLOGISTFORTIS HOSPITAL.
BANGALORE
ECTOPIC PREGNANCYSUBCHORIONIC HEMATOMA
PLACENTAL ABRUPTIONVASA PREVIA
SUCCENTURIATE PLACENTAUTERINE RUPTURE
FIBROID DEGENERATIONCERVICAL INCOMPETENCE
ECTOPIC PREGNANACY
RIGHT THING IN THE
WRONG PLACE
IGNITED HUMAN BOMB
LOCATIONINTRAUTERINE EXTRAUTERINE
CORNUAL TUBAL-95% INTERSTITIAL-2.5% OVARIAN-0.5% CERVICAL-0.1% ABDOMINAL -.1%
HETEROTOPIC PREGNANCY 1 IN 3 00 000 (HIGHER IN IVF PREG)
PREGNANCT TESTING• URINE PREGNANCY TEST(ELISA)
• SERUM BETA HCG- - EXTREMELY RELIABLE - (POSITIVE WITHIN 7 DAYS OF CONCEPTION)
• LEVELS <10mIU/L MAY NOT BE DETECTED(FALSE NEGATIVE TEST)
LIMITATION OF PREGNANCY TESTS
CANNOT DIFFERENTIATE
• ECTOPIC GESTATION• INRAUTERINE NORMAL/ABNORMAL GESTATION• SPONTANEOUS ABORTION
SONOGRAPHY MAY SHOW
• TRUE INRAUTERINE GETATIONAL SAC - DOUBLE DECIDUAL SAC SIGN -YOLK SAC(10 MM GEST.SAC) -FOETAL POLE(16MM GEST.SAC) -CARDIAC ACTIVITY(CRL-5 MM )
• THIS RULES OUT AN ECTOPIC AS HETEROTOPIC PREGNANCY IS RARE
EVOLUTION OF NORMAL IU PREGNANCY
0
100
1stQtr
4thQtr
EasWesNor
DOUBLE DECIDUAL SAC SIGN
TRUE IU GESTATIONAL SAC
NEGATIVE TVS• NO IU GESTATIONAL SAC• NO ADNEXAL ABNORMALITY
POSSIBLITIES ARE
• EARLY SPONTANEOUS ABORTION• EARLY IU NORMAL/ABNORMAL GESTATION• ECTOPIC GESTATION
BETA HCG
• IU GESTATIONAL SAC SHOLD BE SEEN ON TVS WITH A BETA HCG OF 1000mIU/L
• IF NOT THE POSSIBILITY OF AN ECTOPIC IS VERY LIKELY
BETA HCG• TIME Miu/l
• 1 week 0-50• 2 week 20-500• 3 week 500-5000• 4 week 3000-19000• 8 week 14000-16000• 12 week 16000-160000
SERIAL BETA HCG AT 48 HRS
VALUE DECREASES - SPONTANEOUS ABORTION
VALUE DOUBLES - IN 85% OF NORMAL IU GEST(4-6 WKS) - IN 13% OF ECTOPICS
VALUE INCREASES SUBNORMALLY(<66%) - IN 80% OF ECTOPIC GESTATION - IN 15% OF IU GEST
VALUE INCRESES OR DECREASES - ABNORMAL IU GESTATION (MOLE / BLIGHTED OVUM)
REPEAT TVS• IU DDSS/FOETAL POLE
• BLIGHTED OVUM/MOLAR PREG
• ADNEXAL MASS/FREE FLUID-ECTOPIC
• NO ABNORMAL FINDINGS-HIGHLY SUSPICIOUS FOR AN ECTOPIC-LAPROSCOPY
TVS FINDINGS IN ECTOPIC GESTATION
• PSEUDO INTRAUTERINE SAC• ADNEXAL SAC• ADNEXAL SAC WITH YOLK SAC• ADNEXAL SAC WITH FOETAL POLE• ADNEXAL NODULE• ADNEXAL MASS• ADNEXAL MASS WITH TURBID FLUID
PSEUDOGESTATIONAL SAC10% 0F ECTOPICS
CLASSICAL TUBAL ECTOPIC
T2 WI OF ECTOPIC SAC
ECTOPIC SAC WITHOUT YS
ECTOPIC SAC WITH YOLK SAC
INCREASE IN SIZE OF ECTOPIC TWO DAYS LATER
POST MTP ECTOPIC
FOURTH ECTOPIC
DEAD EMBRYO IN ECTOPIC SAC
POST MTP CHRONIC DEAD ECTOPIC
POST MTP LIVE ECTOPIC
CARDIAC ACTIVITY IN LIVE ECTOPIC
INVITRO SCAN OF UNRUPTURED SAC MILKED OUT
FROM TUBE
TUBAL HEMATOCELE
RT TUBAL HEMATOCELE
UNRUPTURED TUBAL HEMATOCELE
TUBAL HEMATOCELE
LARGE TUBAL HEMATOCELE
T2WI OF TUBAL HEMATOCELE
RUPTURED TUBE
RUPTURED TUBE
ECTOPIC WITH PERI TUBAL HEMOPERITONEUM
RUPTURED ECTOPIC WITH HEMOPERITONEUM
RUPTURED ECTOPIC
RUPTURED CHRONIC ECTOPIC
CHRONIC RUPTURED ECTOPIC
TUBAL ABORTION
RIGHT CORNUAL ECTOPIC
T2WI IN RT CORNUAL ECTOPIC
OVARIAN ECTOPIC
HETEROTOPIC PREGNANCY
HETEROTOPIC PREGNANCY
DOPPLER IN ECTOPIC
1 st PREG RUPTURED ECTOPIC-HEMOPERITONEUM
CT IN HEMOPERITONEUM
2 nd-ECTOPIC MANAGED WITH METHOTREXATE
CORPUS LUTEAL CYST MIMIKING ECTOPIC
DD
SUBSEROUS FIBROID MIMIKING ECTOPIC
RT OVARIAN CORPUS HEMORRHAGICUM
WHERE IS THE ECTOPIC?
TVS NEXT DAY SHOWED THE ECTOPIC
?CORPUS LUTEAL CYST ?ECTOPIC
ONE DAY LATER THE ECTOPIC WAS FOUND
LOOK AT THE DIFFERENCE BETWEEN ECTOPIC AND CORPUS LUTEAL CYST
CORPUS LUTEAL CYST
WHAT IS IT ?
DEVELOP A SONIC EYE
PROTOCOL IN DIAGNOSING ECTOPIC
SUBCHORIONIC HEMATOMA
PLACENTAL ABRUPTION AND RETROPLACENTAL HEMATOMA
ECHOPATTERNS OF RETROPLACENTAL HEMATOMAS
VASA PREVIA-VELAMENTOUS INSERTION OF
CORD
TYPES OF VASA PREVIA
COMPLICATIONS OF VASA PREVIA
CORD VESSELS CLOSELY APPOSED TO THE CERVICAL INNER OS
SUCCENTURIATE PLACENTA
SUCCENTURIATE PLACENTA WITH BRIDGING VESSELS
BILOBATE PLACENTA WITH CORD INSERTION INBETWEEN
MRI IN VASA PREVIA
BILOBED VS SUCCENTURIATEPLACENTA
UTERINE RUPTURE
FIBROID DEGENERATION IN PREGNANCY-
CYSTIC/RED/MYXOID TYPES
CERVICAL INCOMPETENCETAS/TVS
CERVICAL INCOMPETENCE
THANK YOU
DR S PRADEEP.