December 24, 2024

34-year-old gravida 1 para 0 presents with a complaint of abdominal pain

By Med-Challenger · 1 minute read

A 34-year-old gravida 1 para 0 presents with a complaint of abdominal pain. It is a vague, achy sort of pain that "comes and goes." She notes that her period should have come about 2 weeks earlier, but it did not. She has also noticed some irregular vaginal spotting. You perform ultrasonography (see figure).

image (47) Figure.

Assuming the embryo in this picture demonstrates cardiac activity, ultrasonography shows the most specific sonographic sign of an ectopic pregnancy. If this is not seen, which of the following is the next most specific sonographic sign of ectopic pregnancy?

decidual cyst within endometrial cavity
complex pelvic fluid
complex or solid adnexal mass separate from the ovary
extrauterine gestational sac containing a yolk sac with or without an embryo
tubal ring without an embryo or yolk sac

The correct answer is:

extrauterine gestational sac containing a yolk sac with or without an embryo

On transvaginal ultrasonography, the pathognomonic finding of an ectopic pregnancy is seen in 8%-26% of ectopic pregnancies. An extrauterine gestational sac containing a yolk sac with or without an embryo is the second most specific sign, but it may be confused with a hemorrhagic cyst containing debris that mimics a yolk sac or embryo. A tubal ring without an embryo or yolk sac has a specificity rate of 40%-68%, which is slightly higher than that of a complex or solid adnexal mass separate from the ovary. Complex pelvic fluid in the presence of a positive human chorionic gonadotropin level and no intrauterine pregnancy suggests ectopic pregnancy; however, it is not specific on its own. Finally, a decidual cyst may be found in either an ectopic or intrauterine pregnancy.

References:

Haury DE, Salhi BA. Acute complications of pregnancy. Marx JA, et al. Rosen's Emergency Medicine. 7th ed., 2009:2279-2297.

Lobo RA. Ectopic pregnancy. Lentz GM, et al. Comprehensive Gynecology. 6th ed., 2012:361-382.

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