3D Pathology: Ectopic Pregnancy 1st Trimester TA
3D Pathology: Ectopic Pregnancy 1st Trimester TA
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3D Pathology: Ectopic Pregnancy 1st Trimester TA
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<p begin="00:00:08.017" end="00:00:10.272">- [Narrator] A curved or<br />phased array transducer</p>
<p begin="00:00:10.272" end="00:00:12.101">with an obstetric exam type is used</p>
<p begin="00:00:12.101" end="00:00:14.569">to perform a trans-abdominal examination</p>
<p begin="00:00:14.569" end="00:00:17.273">to evaluate an ectopic pregnancy.</p>
<p begin="00:00:17.273" end="00:00:20.488">It is helpful for the patients<br />to have a full bladder</p>
<p begin="00:00:20.488" end="00:00:23.205">to complete this examination.</p>
<p begin="00:00:23.205" end="00:00:25.967">The transducer is placed in<br />a longitudinal orientation</p>
<p begin="00:00:25.967" end="00:00:29.996">in the midline at the level<br />of the symphysis pubis.</p>
<p begin="00:00:29.996" end="00:00:31.468">The orientation marker is directed</p>
<p begin="00:00:31.468" end="00:00:33.325">towards the patient's head.</p>
<p begin="00:00:33.325" end="00:00:35.935">The transducer is placed<br />above the pubic symphysis</p>
<p begin="00:00:35.935" end="00:00:39.376">and angled into the pelvis<br />to visualize the bladder</p>
<p begin="00:00:39.376" end="00:00:42.115">which appears as an anechoic<br />triangular structure.</p>
<p begin="00:00:42.115" end="00:00:45.942">The uterus is echogenic<br />or gray in appearance</p>
<p begin="00:00:45.942" end="00:00:50.266">and can be seen directly<br />posterior to the bladder.</p>
<p begin="00:00:50.266" end="00:00:51.783">The endometrial stripe will appear</p>
<p begin="00:00:51.783" end="00:00:54.069">as a bright echogenic line</p>
<p begin="00:00:54.069" end="00:00:56.809">from the uterine fundus to the cervix.</p>
<p begin="00:00:56.809" end="00:00:59.865">Posterior to the uterus<br />is the rectouterine pouch</p>
<p begin="00:00:59.865" end="00:01:03.035">which should be evaluated for free fluid.</p>
<p begin="00:01:03.035" end="00:01:05.502">The transducer should be<br />swept from side to side</p>
<p begin="00:01:05.502" end="00:01:07.268">to see the entire uterus.</p>
<p begin="00:01:07.268" end="00:01:09.623">The transducer is then placed<br />in a transverse orientation</p>
<p begin="00:01:09.623" end="00:01:11.887">in the midline at the level<br />of the symphysis pubis.</p>
<p begin="00:01:11.887" end="00:01:14.720">The orientation marker is directed</p>
<p begin="00:01:15.803" end="00:01:18.543">towards the patient's right.</p>
<p begin="00:01:18.543" end="00:01:20.852">The transducer is placed<br />above the pubic symphysis</p>
<p begin="00:01:20.852" end="00:01:23.275">and angled into the pelvis<br />to visualize the bladder.</p>
<p begin="00:01:23.275" end="00:01:27.735">The uterus can be seen as an<br />echogenic circular structure</p>
<p begin="00:01:27.735" end="00:01:31.131">directly posterior to the bladder.</p>
<p begin="00:01:31.131" end="00:01:32.421">The endometrium will appear</p>
<p begin="00:01:32.421" end="00:01:34.595">as a hyperechoic horizontal line.</p>
<p begin="00:01:34.595" end="00:01:39.485">The transducer should be<br />swept superiorly to inferiorly</p>
<p begin="00:01:39.485" end="00:01:41.749">to see the entire uterus.</p>
<p begin="00:01:41.749" end="00:01:43.854">In a patient with a<br />suspected ectopic pregnancy,</p>
<p begin="00:01:43.854" end="00:01:46.707">the presence of an intrauterine pregnancy</p>
<p begin="00:01:46.707" end="00:01:49.197">makes the diagnosis unlikely.</p>
<p begin="00:01:49.197" end="00:01:51.710">The earliest sign of<br />pregnancy seen by ultrasound</p>
<p begin="00:01:51.710" end="00:01:54.201">is the gestational sac.</p>
<p begin="00:01:54.201" end="00:01:58.547">However, a decidual cyst<br />or pseudogestational sac,</p>
<p begin="00:01:58.547" end="00:02:00.721">which can be seen in an ectopic pregnancy</p>
<p begin="00:02:00.721" end="00:02:03.551">may be confused for a gestational sac.</p>
<p begin="00:02:03.551" end="00:02:06.675">Therefore definitive sonographic evidence</p>
<p begin="00:02:06.675" end="00:02:09.709">of an intrauterine pregnancy<br />should only be established</p>
<p begin="00:02:09.709" end="00:02:12.448">when a gestational sac<br />containing a yolk sac</p>
<p begin="00:02:12.448" end="00:02:15.935">is identified in to planes<br />within the endometrium.</p>
<p begin="00:02:15.935" end="00:02:20.531">A gestational sac can be seen<br />within the uterine cavity</p>
<p begin="00:02:20.531" end="00:02:23.157">by about six weeks gestational age</p>
<p begin="00:02:23.157" end="00:02:26.598">using trans-abdominal ultrasound.</p>
<p begin="00:02:26.598" end="00:02:28.115">The gestational sac appears</p>
<p begin="00:02:28.115" end="00:02:30.511">as an anechoic fluid<br />filled circular structure</p>
<p begin="00:02:30.511" end="00:02:33.024">surrounded by two hypoechoic rings</p>
<p begin="00:02:33.024" end="00:02:35.189">within the mid-portion of the uterus.</p>
<p begin="00:02:35.189" end="00:02:39.219">The yolk sac can be seen<br />by six and a half weeks</p>
<p begin="00:02:39.219" end="00:02:43.068">and appears as a small<br />bright hyperechoic ring</p>
<p begin="00:02:43.068" end="00:02:45.853">within the gestational sac.</p>
<p begin="00:02:45.853" end="00:02:48.954">A fetal pole or fetus can be<br />seen attached to the yolk sac</p>
<p begin="00:02:48.954" end="00:02:50.833">by seven weeks</p>
<p begin="00:02:50.833" end="00:02:54.524">and fetal cardiac motion should<br />be seen after seven weeks.</p>
<p begin="00:02:54.524" end="00:02:59.293">If no evidence of an intrauterine<br />pregnancy can be seen,</p>
<p begin="00:02:59.293" end="00:03:01.240">the adnexal structures can be evaluated</p>
<p begin="00:03:01.240" end="00:03:03.934">for signs of an ectopic pregnancy.</p>
<p begin="00:03:03.934" end="00:03:07.126">The transducer should be slowly<br />swept to the lateral aspects</p>
<p begin="00:03:07.126" end="00:03:08.349">of the pelvis.</p>
<p begin="00:03:08.349" end="00:03:10.364">The ovaries appear as round</p>
<p begin="00:03:10.364" end="00:03:13.149">or oval shaped hypoechoic structures</p>
<p begin="00:03:13.149" end="00:03:16.160">and are often located<br />anterior to the iliac vessels.</p>
<p begin="00:03:16.160" end="00:03:18.627">Follicles may appear</p>
<p begin="00:03:18.627" end="00:03:22.997">as multiple hypoechoic cystic<br />structures within the ovaries.</p>
<p begin="00:03:22.997" end="00:03:25.261">Some follicles may be quite prominent</p>
<p begin="00:03:25.261" end="00:03:27.140">depending on the luteal stage.</p>
<p begin="00:03:27.140" end="00:03:30.672">After ovulation, a ruptured<br />follicle may develop</p>
<p begin="00:03:30.672" end="00:03:32.732">into a corpus luteum cyst</p>
<p begin="00:03:32.732" end="00:03:35.902">which will appear as a large<br />anechoic round structure</p>
<p begin="00:03:35.902" end="00:03:39.388">within the ovary and may<br />persist for up to three months.</p>
<p begin="00:03:39.388" end="00:03:42.055">An ectopic pregnancy will appear</p>
<p begin="00:03:42.920" end="00:03:44.980">as a complex echogenic structure</p>
<p begin="00:03:44.980" end="00:03:48.082">and may contain identifiable<br />embryonic structures,</p>
<p begin="00:03:48.082" end="00:03:51.274">including a gestational sac or fetus.</p>
<p begin="00:03:51.274" end="00:03:53.289">Doppler ultrasound may demonstrate</p>
<p begin="00:03:53.289" end="00:03:55.893">a hypervascular ring of fire sign,</p>
<p begin="00:03:55.893" end="00:03:58.836">associated with ectopic pregnancy.</p>
<p begin="00:03:58.836" end="00:04:02.232">Documentation of fetal heart activity</p>
<p begin="00:04:02.232" end="00:04:05.475">in an extrauterine location<br />confirms the diagnosis</p>
<p begin="00:04:05.475" end="00:04:07.716">of an ectopic pregnancy.</p>
<p begin="00:04:07.716" end="00:04:11.701">The adnexal structures should<br />be evaluated bilaterally</p>
<p begin="00:04:11.701" end="00:04:13.919">for evidence of pathology.</p>
<p begin="00:04:13.919" end="00:04:17.406">In patients with a<br />ruptured ectopic pregnancy,</p>
<p begin="00:04:17.406" end="00:04:18.425">free fluid will appear</p>
<p begin="00:04:18.425" end="00:04:22.251">as a hypoechoic or anechoic collection</p>
<p begin="00:04:22.251" end="00:04:24.221">posterior to the uterus.</p>
<p begin="00:04:24.221" end="00:04:26.122">If fluid is seen in the pelvis,</p>
<p begin="00:04:26.122" end="00:04:30.741">a view of Morrison's<br />pouch should be obtained.</p>
<p begin="00:04:30.741" end="00:04:32.462">The probe is moved to<br />the right upper quadrant</p>
<p begin="00:04:32.462" end="00:04:33.639">in the mid-axillary line</p>
<p begin="00:04:33.639" end="00:04:37.056">with the marker facing the patients head.</p>
<p begin="00:04:38.040" end="00:04:40.250">Hemoperitoneum can be seen</p>
<p begin="00:04:40.250" end="00:04:44.417">as a dark hypoechoic stripe<br />between the liver and kidney.</p>
<p begin="00:00:10.272" end="00:00:12.101">with an obstetric exam type is used</p>
<p begin="00:00:12.101" end="00:00:14.569">to perform a trans-abdominal examination</p>
<p begin="00:00:14.569" end="00:00:17.273">to evaluate an ectopic pregnancy.</p>
<p begin="00:00:17.273" end="00:00:20.488">It is helpful for the patients<br />to have a full bladder</p>
<p begin="00:00:20.488" end="00:00:23.205">to complete this examination.</p>
<p begin="00:00:23.205" end="00:00:25.967">The transducer is placed in<br />a longitudinal orientation</p>
<p begin="00:00:25.967" end="00:00:29.996">in the midline at the level<br />of the symphysis pubis.</p>
<p begin="00:00:29.996" end="00:00:31.468">The orientation marker is directed</p>
<p begin="00:00:31.468" end="00:00:33.325">towards the patient's head.</p>
<p begin="00:00:33.325" end="00:00:35.935">The transducer is placed<br />above the pubic symphysis</p>
<p begin="00:00:35.935" end="00:00:39.376">and angled into the pelvis<br />to visualize the bladder</p>
<p begin="00:00:39.376" end="00:00:42.115">which appears as an anechoic<br />triangular structure.</p>
<p begin="00:00:42.115" end="00:00:45.942">The uterus is echogenic<br />or gray in appearance</p>
<p begin="00:00:45.942" end="00:00:50.266">and can be seen directly<br />posterior to the bladder.</p>
<p begin="00:00:50.266" end="00:00:51.783">The endometrial stripe will appear</p>
<p begin="00:00:51.783" end="00:00:54.069">as a bright echogenic line</p>
<p begin="00:00:54.069" end="00:00:56.809">from the uterine fundus to the cervix.</p>
<p begin="00:00:56.809" end="00:00:59.865">Posterior to the uterus<br />is the rectouterine pouch</p>
<p begin="00:00:59.865" end="00:01:03.035">which should be evaluated for free fluid.</p>
<p begin="00:01:03.035" end="00:01:05.502">The transducer should be<br />swept from side to side</p>
<p begin="00:01:05.502" end="00:01:07.268">to see the entire uterus.</p>
<p begin="00:01:07.268" end="00:01:09.623">The transducer is then placed<br />in a transverse orientation</p>
<p begin="00:01:09.623" end="00:01:11.887">in the midline at the level<br />of the symphysis pubis.</p>
<p begin="00:01:11.887" end="00:01:14.720">The orientation marker is directed</p>
<p begin="00:01:15.803" end="00:01:18.543">towards the patient's right.</p>
<p begin="00:01:18.543" end="00:01:20.852">The transducer is placed<br />above the pubic symphysis</p>
<p begin="00:01:20.852" end="00:01:23.275">and angled into the pelvis<br />to visualize the bladder.</p>
<p begin="00:01:23.275" end="00:01:27.735">The uterus can be seen as an<br />echogenic circular structure</p>
<p begin="00:01:27.735" end="00:01:31.131">directly posterior to the bladder.</p>
<p begin="00:01:31.131" end="00:01:32.421">The endometrium will appear</p>
<p begin="00:01:32.421" end="00:01:34.595">as a hyperechoic horizontal line.</p>
<p begin="00:01:34.595" end="00:01:39.485">The transducer should be<br />swept superiorly to inferiorly</p>
<p begin="00:01:39.485" end="00:01:41.749">to see the entire uterus.</p>
<p begin="00:01:41.749" end="00:01:43.854">In a patient with a<br />suspected ectopic pregnancy,</p>
<p begin="00:01:43.854" end="00:01:46.707">the presence of an intrauterine pregnancy</p>
<p begin="00:01:46.707" end="00:01:49.197">makes the diagnosis unlikely.</p>
<p begin="00:01:49.197" end="00:01:51.710">The earliest sign of<br />pregnancy seen by ultrasound</p>
<p begin="00:01:51.710" end="00:01:54.201">is the gestational sac.</p>
<p begin="00:01:54.201" end="00:01:58.547">However, a decidual cyst<br />or pseudogestational sac,</p>
<p begin="00:01:58.547" end="00:02:00.721">which can be seen in an ectopic pregnancy</p>
<p begin="00:02:00.721" end="00:02:03.551">may be confused for a gestational sac.</p>
<p begin="00:02:03.551" end="00:02:06.675">Therefore definitive sonographic evidence</p>
<p begin="00:02:06.675" end="00:02:09.709">of an intrauterine pregnancy<br />should only be established</p>
<p begin="00:02:09.709" end="00:02:12.448">when a gestational sac<br />containing a yolk sac</p>
<p begin="00:02:12.448" end="00:02:15.935">is identified in to planes<br />within the endometrium.</p>
<p begin="00:02:15.935" end="00:02:20.531">A gestational sac can be seen<br />within the uterine cavity</p>
<p begin="00:02:20.531" end="00:02:23.157">by about six weeks gestational age</p>
<p begin="00:02:23.157" end="00:02:26.598">using trans-abdominal ultrasound.</p>
<p begin="00:02:26.598" end="00:02:28.115">The gestational sac appears</p>
<p begin="00:02:28.115" end="00:02:30.511">as an anechoic fluid<br />filled circular structure</p>
<p begin="00:02:30.511" end="00:02:33.024">surrounded by two hypoechoic rings</p>
<p begin="00:02:33.024" end="00:02:35.189">within the mid-portion of the uterus.</p>
<p begin="00:02:35.189" end="00:02:39.219">The yolk sac can be seen<br />by six and a half weeks</p>
<p begin="00:02:39.219" end="00:02:43.068">and appears as a small<br />bright hyperechoic ring</p>
<p begin="00:02:43.068" end="00:02:45.853">within the gestational sac.</p>
<p begin="00:02:45.853" end="00:02:48.954">A fetal pole or fetus can be<br />seen attached to the yolk sac</p>
<p begin="00:02:48.954" end="00:02:50.833">by seven weeks</p>
<p begin="00:02:50.833" end="00:02:54.524">and fetal cardiac motion should<br />be seen after seven weeks.</p>
<p begin="00:02:54.524" end="00:02:59.293">If no evidence of an intrauterine<br />pregnancy can be seen,</p>
<p begin="00:02:59.293" end="00:03:01.240">the adnexal structures can be evaluated</p>
<p begin="00:03:01.240" end="00:03:03.934">for signs of an ectopic pregnancy.</p>
<p begin="00:03:03.934" end="00:03:07.126">The transducer should be slowly<br />swept to the lateral aspects</p>
<p begin="00:03:07.126" end="00:03:08.349">of the pelvis.</p>
<p begin="00:03:08.349" end="00:03:10.364">The ovaries appear as round</p>
<p begin="00:03:10.364" end="00:03:13.149">or oval shaped hypoechoic structures</p>
<p begin="00:03:13.149" end="00:03:16.160">and are often located<br />anterior to the iliac vessels.</p>
<p begin="00:03:16.160" end="00:03:18.627">Follicles may appear</p>
<p begin="00:03:18.627" end="00:03:22.997">as multiple hypoechoic cystic<br />structures within the ovaries.</p>
<p begin="00:03:22.997" end="00:03:25.261">Some follicles may be quite prominent</p>
<p begin="00:03:25.261" end="00:03:27.140">depending on the luteal stage.</p>
<p begin="00:03:27.140" end="00:03:30.672">After ovulation, a ruptured<br />follicle may develop</p>
<p begin="00:03:30.672" end="00:03:32.732">into a corpus luteum cyst</p>
<p begin="00:03:32.732" end="00:03:35.902">which will appear as a large<br />anechoic round structure</p>
<p begin="00:03:35.902" end="00:03:39.388">within the ovary and may<br />persist for up to three months.</p>
<p begin="00:03:39.388" end="00:03:42.055">An ectopic pregnancy will appear</p>
<p begin="00:03:42.920" end="00:03:44.980">as a complex echogenic structure</p>
<p begin="00:03:44.980" end="00:03:48.082">and may contain identifiable<br />embryonic structures,</p>
<p begin="00:03:48.082" end="00:03:51.274">including a gestational sac or fetus.</p>
<p begin="00:03:51.274" end="00:03:53.289">Doppler ultrasound may demonstrate</p>
<p begin="00:03:53.289" end="00:03:55.893">a hypervascular ring of fire sign,</p>
<p begin="00:03:55.893" end="00:03:58.836">associated with ectopic pregnancy.</p>
<p begin="00:03:58.836" end="00:04:02.232">Documentation of fetal heart activity</p>
<p begin="00:04:02.232" end="00:04:05.475">in an extrauterine location<br />confirms the diagnosis</p>
<p begin="00:04:05.475" end="00:04:07.716">of an ectopic pregnancy.</p>
<p begin="00:04:07.716" end="00:04:11.701">The adnexal structures should<br />be evaluated bilaterally</p>
<p begin="00:04:11.701" end="00:04:13.919">for evidence of pathology.</p>
<p begin="00:04:13.919" end="00:04:17.406">In patients with a<br />ruptured ectopic pregnancy,</p>
<p begin="00:04:17.406" end="00:04:18.425">free fluid will appear</p>
<p begin="00:04:18.425" end="00:04:22.251">as a hypoechoic or anechoic collection</p>
<p begin="00:04:22.251" end="00:04:24.221">posterior to the uterus.</p>
<p begin="00:04:24.221" end="00:04:26.122">If fluid is seen in the pelvis,</p>
<p begin="00:04:26.122" end="00:04:30.741">a view of Morrison's<br />pouch should be obtained.</p>
<p begin="00:04:30.741" end="00:04:32.462">The probe is moved to<br />the right upper quadrant</p>
<p begin="00:04:32.462" end="00:04:33.639">in the mid-axillary line</p>
<p begin="00:04:33.639" end="00:04:37.056">with the marker facing the patients head.</p>
<p begin="00:04:38.040" end="00:04:40.250">Hemoperitoneum can be seen</p>
<p begin="00:04:40.250" end="00:04:44.417">as a dark hypoechoic stripe<br />between the liver and kidney.</p>
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https://youtu.be/AP2YzFosOWo