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.