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Abdominal Radiology
Published in: Abdominal Radiology 3/2021

01-03-2021 | Magnetic Resonance Imaging | Review

The many faces of ectopic pregnancies: demystifying the common and less common entities

Authors: F. Eymen Ucisik-Keser, Eduardo J. Matta, Miguel G. Fabrega, Chitra Chandrasekhar, Steven S. Chua

Published in: Abdominal Radiology | Issue 3/2021

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Abstract

Ectopic pregnancy is a major cause of 1st trimester pregnancy deaths. It occurs in various locations in the abdominopelvic cavity. Ultrasonography is a first-line, rapid, and noninvasive modality for ectopic pregnancy evaluation. MRI can help clarify equivocal cases. When in doubt about the location, one should give an intrauterine pregnancy the benefit of the doubt with close ultrasound and hCG follow-up. Here, we will review the imaging findings and mimickers of ectopic pregnancies.

Graphic Abstract

Literature
1.
Goldner TE, Lawson HW, Xia Z, Atrash HK (1993) Surveillance for ectopic pregnancy—United States, 1970–1989. MMWR CDC Surveill Summ 42(6):73-85
2.
Creanga AA, Shapiro-Mendoza CK, Bish CL, Zane S, Berg CJ, Callaghan WM (2011) Trends in ectopic pregnancy mortality in the United States: 1980–2007. Obstet Gynecol 117(4):837-43
3.
Berg CJ, Callaghan WM, Syverson C, Henderson Z (2011) Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol 117(5):1230
4.
Barnhart KT, Sammel MD, Gracia CR, Chittams J, Hummel AC, Shaunik A (2006) Risk factors for ectopic pregnancy in women with symptomatic first-trimester pregnancies. Fertil Steril 86(1):36-43
5.
Graczykowski JW, Seifer DB (1999) Diagnosis of acute and persistent ectopic pregnancy. Clin Obstet Gynecol 42(1):9-22
6.
Mehta TS, Levine D, Beckwith B (1997) Treatment of ectopic pregnancy: is a human chorionic gonadotropin level of 2,000 mIU/mL a reasonable threshold?. Radiology 205(2):569-73
7.
Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy (2008). Radiographics 28(6):1661-71
8.
Knight S, Teismann N (2019) First-Trimester Pregnancy. In: Nilam JS (ed) Point of Care Ultrasound, 2nd edn. Elsevier, Philadelphia, pp 263-265
9.
Wu R, Klein MA, Mahboob S, Gupta M, Katz DS (2013) Magnetic resonance imaging as an adjunct to ultrasound in evaluating cesarean scar ectopic pregnancy. J Clin Imaging Sci 3
10.
Kadar N, Taylor KJ, Rosenfield AT, Romero R (1983) Combined use of serum HCG and sonography in the diagnosis of ectopic pregnancy. AJR Am J Roentgenol 141(3):609-15
11.
Saxon D, Falcone T, Mascha EJ, Marino T, Yao M, Tulandi T (1997) A study of ruptured tubal ectopic pregnancy. Obstet Gynecol 90(1):46-9
12.
Baque P, Iannelli A, Dausse F, de Peretti F, Bourgeon A (2005) A new method to approach exact hemoperitoneum volume in a splenic trauma model using ultrasonography. Surg Radiol Anat 27(3):249-53
13.
Bouyer J, Coste J, Fernandez H, Pouly JL, Job-Spira N (2002) Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 17(12):3224-30
14.
Brown DL, Doubilet PM (1994) Transvaginal sonography for diagnosing ectopic pregnancy: positivity criteria and performance characteristics. J Ultrasound Med 13(4):259-66
15.
Tulandi T (2020) Ectopic pregnancy: Clinical manifestations and diagnosis. In: Post TW (ed) UpToDate, UpToDate, Massachusetts. Accessed 4 July 2020
16.
Parker III RA, Yano M, Tai AW, Friedman M, Narra VR, Menias CO (2012) MR imaging findings of ectopic pregnancy: a pictorial review. Radiographics 32(5):1445-60
17.
Arleo EK, DeFilippis EM (2014) Cornual, interstitial, and angular pregnancies: clarifying the terms and a review of the literature. Clin Imaging 38(6):763-70
18.
Baldawa PS, Chaudhari HK (2008) Angular ectopic pregnancy presenting as rupture of lateral wall of the uterus. J Hum Reprod Sci 1(1):33-4
19.
Filhastre M, Dechaud H, Lesnik A, Taourel P (2005) Interstitial pregnancy: role of MRI. Eur Radiol 15(1):93-5
20.
Lewiss RE, Shaukat NM, Saul T (2014) The endomyometrial thickness measurement for abnormal implantation evaluation by pelvic sonography. J Ultrasound Med 33(7):1143-6
21.
Fleischer AC, Pennell RG, McKee MS, Worrell JA, Keefe B, Herbert CM, Hill GA, Cartwright PS, Kepple DM (1990) Ectopic pregnancy: features at transvaginal sonography. Radiology 174(2):375-8
22.
Timor-Tritsch IE, Rottem S. Transvaginal ultrasonographic study of the fallopian tube (1987). Obstet Gynecol 70(3 Pt 1):424-8
23.
Gavrilova-Jordan L, Tatpati L, Famuyide A (2006) Primary ovarian pregnancy after donor embryo transfer: early diagnosis and laparoscopic treatment. JSLS 10(1):70-3
24.
Balat O, Kutlar I, Ozkur A, Bakir K, Aksoy F, Ugur MG (2004) Primary pure ovarian choriocarcinoma mimicking ectopic pregnancy: a report of fulminant progression. Tumori. 90(1):136-8
25.
Rotas MA, Haberman S, Levgur M (2006). Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 107(6):1373-81
26.
Ouyang Y, Li X, Yi Y, Gong F, Lin G, Lu G (2015) First-trimester diagnosis and management of Cesarean scar pregnancies after in vitro fertilization-embryo transfer: a retrospective clinical analysis of 12 cases. Reprod Biol Endocrinol 1;13(1):126
27.
Timor‐Tritsch IE, Monteagudo A, Cali G, Vintzileos A, Viscarello R, Al‐Khan A, Zamudio S, Mayberry P, Cordoba MM, Dar P (2014). Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound Obstet Gynecol 44(3):346-53
28.
Cheng LY, Wang CB, Chu LC, Tseng CW, Kung FT (2014) Outcomes of primary surgical evacuation during the first trimester in different types of implantation in women with cesarean scar pregnancy. Fertil Steril 102(4):1085-1090
29.
Atri M, Leduc C, Gillett P, Bret PM, Reinhold C, Kintzen G, Aldis AE (1996) Role of endovaginal sonography in the diagnosis and management of ectopic pregnancy. Radiographics 16(4):755-74
30.
Osborn DA, Williams TR, Craig BM (2012) Cesarean scar pregnancy: sonographic and magnetic resonance imaging findings, complications, and treatment. J Ultrasound Med 31(9):1449-56
31.
Shavell VI, Abdallah ME, Zakaria MA, Berman JM, Diamond MP, Puscheck EE (2012) Misdiagnosis of cervical ectopic pregnancy. Arch Gynecol Obstet 285(2):423-6
32.
Jurkovic D, Hacket E, Campbell S (1996) Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively. Ultrasound Obstet Gynecol 8(6):373-80
33.
Vas W, Suresh PL, Tang‐Barton P, Salimi Z, Carlin B (1984) Ultrasonographic differentiation of cervical abortion from cervical pregnancy. J Clin Ultrasound 12(9):553-7
34.
Chukus A, Tirada N, Restrepo R, Reddy NI (2015) Uncommon implantation sites of ectopic pregnancy: thinking beyond the complex adnexal mass. Radiographics 35(3):946-59
35.
Studdiford WE (1942) Primary peritoneal pregnancy. Am J Obstet Gynecol 44(3):487-91
36.
Poole A, Haas D, Magann EF (2012) Early abdominal ectopic pregnancies: a systematic review of the literature. Gynecol Obstet Invest 74(4):249-60
37.
Malian V, Lee JE (2001) MR imaging and MR angiography of an abdominal pregnancy with placental infarction. AJR Am J Roentgenol 177(6):1305-6
38.
Allibone GW, Fagan CJ, Porter SC (1981) The sonographic features of intra‐abdominal pregnancy. J Clin Ultrasound 9(7):383-7
39.
Kirk E, McDonald K, Rees J, Govind A (2013) Intramural ectopic pregnancy: a case and review of the literature. Eur J Obstet Gynecol Reprod Biol 168(2):129-33
40.
Zhang Q, Xing X, Liu S, Xie X, Liu X, Qian F, Liu Y (2019). Intramural ectopic pregnancy following pelvic adhesion: case report and literature review. Arch Gynecol Obstet 300(6):1507-1520
41.
Winer AE, Bergman WD, Fields C. Combined intra-and extrauterine pregnancy (1957) Am J Obstet Gynecol 74(1):170-8
42.
Fernandez H, Gervaise A (2004) Ectopic pregnancies after infertility treatment: modern diagnosis and therapeutic strategy. Hum Reprod Update 10(6):503-13
43.
Lewis AD, Levine D (2010) Pregnancy complications in women with uterine duplication abnormalities. Ultrasound Q 26(4):193-200
44.
Herchelroath D, Miller JL, Wang KC (2018) Novel management of ectopic pregnancy in a noncommunicating rudimentary horn of a unicornuate uterus. J Am Osteopath Assoc 118(9):623-626
45.
Arslan T, Bilgiç E, Şentürk MB, Yücel N (2009) Rudimentary uterine horn pregnancy: a mystery diagnosis. Fertil Steril 92(6):2037.e1-3
46.
Nahum GG. Rudimentary uterine horn pregnancy (2002) The 20th-century worldwide experience of 588 cases. J Reprod Med 47(2):151-63
47.
Mangili G, Lorusso D, Brown J, Pfisterer J, Massuger L, Vaughan M, Ngan HY, Golfier F, Sekharan PK, Charry RC, Poveda A (2014) Trophoblastic disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. Int J Gynecol Cancer 24(9 Suppl 3):S109-16
48.
Ngan S, Seckl MJ (2007) Gestational trophoblastic neoplasia management: an update. Curr Opin Oncol 19(5):486-91
49.
Freis A, Elsässer M, Sohn C, Fluhr H (2016) Twin Pregnancy with One Fetus and One Complete Mole–A Case Report. Geburtshilfe Frauenheilkd 76(7):819-822
50.
Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease (2010) Lancet 376(9742):717-29
51.
Gillespie AM, Lidbury EA, Tidy JA, Hancock BW (2004) The clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation. Int J Gynecol Cancer 14(2):366-9
52.
Shaaban AM, Rezvani M, Haroun RR, Kennedy AM, Elsayes KM, Olpin JD, Salama ME, Foster BR, Menias CO (2017) Gestational trophoblastic disease: clinical and imaging features. Radiographics 37(2):681-700
Metadata
Title
The many faces of ectopic pregnancies: demystifying the common and less common entities
Authors
F. Eymen Ucisik-Keser
Eduardo J. Matta
Miguel G. Fabrega
Chitra Chandrasekhar
Steven S. Chua
Publication date
01-03-2021
Publisher
Springer US
Published in
Abdominal Radiology / Issue 3/2021
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-020-02681-6

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