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First trimester bleeding ultrasound evaluation

Zaigui Wu, Xinmei Zhang, Ping Xu, Xiufeng Huang
OBJECTIVES: The purpose of this study was to evaluate the clinical characteristics, prenatal diagnosis, and management of patients with heterotopic pregnancy after ovulation induction or embryo transfer. METHODS: This was a retrospective study of fifty cases with heterotopic pregnancy, in which the fertilization way, type and number of embryo transferred, gestational age, clinical presentation and outcome of intrauterine, ultrasound presentation and site of ectopic pregnancy, bilateral fallopian tube and treatment were evaluated...
April 16, 2018: European Journal of Medical Research
Polina Rovner, Elaine Stickrath, Meredith Alston, Kirsten Lund
In the United Kingdom, early pregnancy assessment clinics have existed since the early 1990s and have become the reference standard for evaluating and treating women with first-trimester pregnancy complications. These units have now been established in many countries and have been found to be effective and efficient, saving money and unnecessary emergency department visits and hospital admissions. To our knowledge, no such model has been described in the United States. A PubMed search using a combination of "early pregnancy unit," "early pregnancy assessment clinic," and "United States," "U...
November 9, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Catherine H Phillips, Jeremy R Wortman, Elizabeth S Ginsburg, Aaron D Sodickson, Peter M Doubilet, Bharti Khurana
The purpose of this article is to help the practitioner ensure early diagnosis and response to emergencies in the first trimester by reviewing anatomy of the developing embryo, highlighting the sonographic appearance of common first-trimester emergencies, and discussing key management pathways for treating emergent cases. First-trimester fetal development is a stepwise process that can be challenging to evaluate in the emergency department (ED) setting. This is due, in part, to the complex anatomy of early pregnancy, subtlety of the sonographic findings, and the fact that fewer than half of patients with ectopic pregnancy present with the classic clinical findings of a positive pregnancy test, vaginal bleeding, pelvic pain, and tender adnexa...
February 2018: Emergency Radiology
Ansa Islam, Aneesa Fawad, Azmat Ali Shah, Humaira Jadoon, Iram Sarwar, Aziz-Un-Nisa Abbasi
BACKGROUND: Ectopic pregnancy is the leading cause of pregnancy related deaths in the first trimester. The aim of this study was to evaluate the frequency of risk factors, clinical presentation, diagnostic methods and site of ectopic pregnancy. METHODS: This descriptive cross sectional study was conducted in Gynaecology and Obstetrical Unit-A of Ayub Teaching Hospital Abbottabad from 1st October 2013 to 31st October 2015. All women diagnosed with ectopic pregnancy were included in the study...
January 2017: Journal of Ayub Medical College, Abbottabad: JAMC
Francesco Cosentino, Cristiano Rossitto, Luigi Carlo Turco, Salvatore Gueli Alletti, Carmine Vascone, Lavinia Di Meglio, Giovanni Scambia, Mario Malzoni
OBJECTIVE: To illustrate the laparoscopic surgical management of a particular localization of extrauterine pregnancy misdiagnosed until 12 weeks gestational age, complicated by hemoperitoneum and abortion. DESIGN: Canadian Task Force III on the Periodic Health Examination's Levels of Evidence. SETTING: The prevalence of ectopic pregnancy among women presenting to an emergency department with first trimester bleeding, pain, or both ranges from 1% to 16% [1]...
July 2017: Journal of Minimally Invasive Gynecology
E Mausner Geffen, C Slywotzky, G Bennett
Women of reproductive age with pelvic pain, vaginal bleeding, and a positive pregnancy test often require evaluation with pelvic ultrasound. In these situations, the primary role of pelvic ultrasound is to differentiate an ectopic pregnancy from either a normal or abnormal intrauterine pregnancy. While an accurately performed and interpreted pelvic ultrasound results in rapid diagnosis and management, numerous diagnostic pitfalls can lead to negative outcomes. Therefore, familiarity with the appropriate laboratory tests, sonographic technique, and imaging features of ectopic pregnancy is essential for all radiologists...
May 2017: Abdominal Radiology
Mallory Hughes, Andrew Lupo, Adrianne Browning
Ectopic pregnancy is commonly seen as a differential diagnosis of first-trimester vaginal bleeding. Often the diagnosis is made based on a combination of exam findings, transvaginal ultrasound, and a positive pregnancy test. Our case describes a patient with a history of ectopic pregnancy treated with methotrexate and serial human chorionic gonadotropin measurements that were decreasing appropriately. At the time of evaluation, her urine pregnancy test was negative; however, she was confirmed to have a ruptured tubal ectopic pregnancy...
January 2017: Proceedings of the Baylor University Medical Center
S Tercanli, F Prüfer
Both in routine diagnostics and detailed, highly specialized workups, major advances have been observed in many areas of ultrasound due to an increase in expertise and improved technology in recent years. This is particularly true in the case of fetal neurosonography 1 2 3 4. Malformations of the CNS together with fetal heart defects are among the most common congenital anomalies. From the embryonic phase to the late third trimester, the CNS undergoes extensive development and maturation processes. The diagnosis of CNS anomalies is therefore primarily dependent on the time at which the examination is performed and the experience of the examiner...
December 2016: Ultraschall in der Medizin
Lucie Morin, Yvonne M Cargill, Phyllis Glanc
OBJECTIVE: OUTCOMES:: EVIDENCE: A MEDLINE search and review of bibliographies identified articles was conducted. VALUES: The evidence collected was reviewed by the Diagnostic Imaging Committee of the Society of Obstetricians and Gynaecologists of Canada. The recommendations were made according to the guidelines developed by The Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS: Women presenting with first trimester bleeding may be incorrectly diagnosed with a missed abortion, may have an ectopic pregnancy overlooked, or may be inappropriately reassured about viability...
October 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
John W Hall, Nicolas Denne, Joseph J Minardi, Debra Williams, B J Balcik
BACKGROUND: Early pregnancy complaints in emergency medicine are common. Emergency physicians (EP) increasingly employ ultrasound (US) in the evaluation of these complaints. As a result, it is likely that rare and important diagnoses will be encountered. We report a case of fetal anencephaly diagnosed by bedside emergency US in a patient presenting with first-trimester vaginal bleeding. CASE REPORT: A 33-year-old patient at 10 weeks gestation presented with vaginal bleeding...
July 2016: Western Journal of Emergency Medicine
Melissa Lavecchia, Haim A Abenhaim
OBJECTIVE: Women with failure of an early pregnancy and a gestational age of <8 weeks are considered good candidates for medical management. The purpose of our study was to evaluate the effect of menstrual age on the outcome of medical management in women with loss of a pregnancy at an estimated gestational age<8 weeks by ultrasound (US). METHODS: We conducted a retrospective cohort study of all women discharged from the emergency department (ED) between 2011 and 2013 with a diagnosis of early pregnancy failure who were managed with misoprostol and who had a gestational age of <8 weeks on US...
July 2015: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Thierry Van den Bosch, Dominique Van Schoubroeck, Dirk Timmerman
OBJECTIVES: The purpose of this study was to evaluate blood loss and procedure-related complications during and after surgical removal of retained products of conception with high-velocity enhanced myometrial vascularity. METHODS: We conducted a prospective study of 18 consecutive women with a diagnosis of retained products of conception and enhanced myometrial vascularity, with a peak systolic velocity (PSV) higher than 60 cm/s. All underwent ultrasound-guided surgical removal of the retained products under general anesthesia...
September 2015: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Antonio Maiorana, Domenico Incandela, Laura Giambanco, Walter Alio, Luigi Alio
Pregnancy, the implantation of a fertilized ovum outside the endometrial cavity, occurs in 1.5%-2% of pregnancies. It is one of the major causes (about 6%) of maternal death during the first trimester of pregnancy. The remaining 5% implant in the ovary, peritoneal cavity, within the cervix, and the omental pregnancy is the least common form of abdominal pregnancies. A review of the literature on Medline for the period 1958-2012 reported only 16 cases of omental pregnancy. Here we report a case of primary omental pregnancy in a nulliparous woman...
2014: Pan African Medical Journal
Fernanda S Mazzariol, Jeffrey Roberts, Sarah K Oh, Zina Ricci, Mordecai Koenigsberg, Marjorie W Stein
Ultrasound is the primary imaging modality used in the evaluation of first-trimester vaginal bleeding and pelvic pain. This article will summarize the ultrasound findings in normal first-trimester pregnancy, failed pregnancy, ectopic pregnancy, subchorionic hemorrhage, retained products of conception, and gestational trophoblastic disease. Mastery of the spectrum of sonographic findings in the normal and abnormal first-trimester pregnancy allows the radiologist to make accurate diagnoses and helps to appropriately guide patient management...
March 2015: Clinical Imaging
S French, T Henry, E W Williams
BACKGROUND: Pregnant female patients with vaginal bleeding in the first trimester are seen commonly in the Emergency Department (ED) at the University Hospital of the West Indies (UHWI), Kingston, Jamaica. The protocol for the management of these patients requires that they have a sonographic evaluation performed for the purpose of localizing the pregnancy where possible, to assist with determining the risk for an ectopic pregnancy. The ultrasound examinations are performed in the radiology department...
June 2014: West Indian Medical Journal
Stefano Zucchini, Elena Marra
Several surgical and/or medical emergencies/urgencies may occur in gynecologic patients and in pregnant women during the first trimester. Particularly, ectopic pregnancies, ruptured or hemorrhagic ovarian cysts, ovarian or adnexal torsions, threatened or inevitable miscarriages, phlogistic gynecological disorders, complications involving the uterine fibroids, endometriosis, and spontaneous uterine rupture are possible acute complications. The diagnosis is suspected on the basis of symptoms (acute pelvic and/or abdominal pain, with or without vaginal bleeding or discharge, until acute abdomen with peritonitis), by means physical evaluation (abdominal, pelvic, and bimanual gynecological examinations), by means of transabdominal (TAS) and/or transvaginal (TVS) sonography, and laboratory tests...
March 2014: Journal of Ultrasound
V Soldo, N Cutura, M Zamurovic
BACKGROUND: Vaginal bleeding during the first half of pregnancy occurs in approximately 25% of women and about half of these pregnancies terminate in abortion. In many instances a retrochorial hematoma (RCH) is sonographically found. OBJECTIVE: The aim of the present study was to determine the frequency of a RCH in the group of threatened miscarriages and to examine the possible relationship of parity, previous miscarriages, hematoma size and localization, and duration of vaginal bleeding to pregnancy outcome...
2013: Clinical and Experimental Obstetrics & Gynecology
Kerri Layman, Michael Antonis, Jonathan E Davis
Background. Bedside sonography performed by emergency physicians is frequently utilized for real-time clinical decision-making in the emergency department (ED) setting. This includes the sonographic evaluation of pain or bleeding in the first trimester of pregnancy. The detection of intrauterine pregnancy (IUP) or life-threatening conditions, including ectopic pregnancy, is critical. Objectives. This paper will review several important pearls and avoidable pitfalls of this diagnostic modality by brief presentation of illustrative cases followed by discussion of key principles...
2013: Emergency Medicine International
S Guha, V Van Belle, C Bottomley, J Preisler, V Vathanan, A Sayasneh, C Stalder, D Timmerman, T Bourne
STUDY QUESTION: Does a logistic regression model and scoring system to predict viability of an intrauterine pregnancy of uncertain viability (PUV) perform as well in an independent patient group as the original patient group? SUMMARY ANSWER: The model and scoring system showed good performance on external validation confirming their value for the prediction of miscarriage/viability in PUV patients up to 11-14 weeks of gestation. WHAT IS KNOWN ALREADY: Several individual ultrasound and demographic factors have been described as predictors for miscarriage...
November 2013: Human Reproduction
Barton F Lane, Jade J Wong-You-Cheong, Marcia C Javitt, Phyllis Glanc, Douglas L Brown, Theodore Dubinsky, Mukesh G Harisinghani, Robert D Harris, Nadia J Khati, Donald G Mitchell, Pari V Pandharipande, Harpreet K Pannu, Anne E Podrasky, Thomas D Shipp, Cary Lynn Siegel, Lynn Simpson, Darci J Wall, Carolyn M Zelop
Vaginal bleeding is not uncommon in the first trimester of pregnancy. Ultrasound is the foremost modality for evaluating normal development of the gestational sac and embryo and for discriminating the causes of bleeding. While correlation with quantitative βHCG and clinical presentation is essential, sonographic criteria permit diagnosis of failed pregnancies, ectopic pregnancy, gestational trophoblastic disease and spontaneous abortion. The American College of Radiology Appropriateness Criteria guidelines have been updated to incorporate recent data...
June 2013: Ultrasound Quarterly
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