The ultrasound appearances of non-tubal ectopic pregnancies
This article provides a comprehensive overview of the ultrasound characteristics of non-tubal ectopic pregnancies, which account for approximately five per cent of all ectopic pregnancies. Unlike tubal ectopics, non-tubal variants pose greater diagnostic challenges and carry increased risks of morbidity and mortality due to delayed recognition. The author emphasises the importance of a systematic transvaginal ultrasound approach, including thorough pelvic surveys and the use of adjuncts like colour Doppler and 3D imaging.
- The article categorises non-tubal ectopics into several types:
- Interstitial pregnancies occur in the intramyometrial segment of the fallopian tube and can expand significantly before rupture. Key ultrasound features include an empty uterine cavity, eccentric gestational sac (GS) and a thin endomyometrial mantle.
- Cervical ectopics implant below the internal os and present with a barrel-shaped canal and absent sliding sign, distinguishing them from cervical miscarriages.
- Caesarean scar pregnancies implant within the myometrial defect of a previous scar, often showing a GS in the anterior isthmus with high velocity blood flow on Doppler.
- Ovarian ectopics are rare and difficult to diagnose, typically showing a GS embedded in ovarian tissue with a wide echogenic ring.
- Abdominal ectopics may result from primary fertilisation in the abdomen or secondary migration, often diagnosed late and associated with high mortality
- Intramural pregnancies involve GS implantation within the myometrium, often following uterine surgery.
The article concludes by stressing early detection and expert input to improve outcomes in these complex cases.
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