Ectopic Pregnancy

• Classic Triad of symptoms: irregular mestrual bleeding, pain, palpable adnexal mass
• gestational sac seen only if bHCG greater than 2000 IU/L
• Location: fallopian tubes (95%), in ampullary or isthmus
• heterotopic pregnancy 1 in 7000 pregnancies.

Risk Factors

• prior infection
• developmental defects or prior tubal surgery
• IUD
• ovulation-inducing agents
• IVF
• prior ectopic

Intrauterine Findings

• normal or thickened endometrial lining
• look for IUP (gestational sac with yolk sac and DDS sign)

Extrauterine findings

• extrauterine embryo with positive heart motion (100% PPV)
• adnexal mass containing a yolk sac or nonliving embryo (100%)
• Ring of Fire = “tubal” or “adnexal” ring surrounding a fluid collection (95%)
• Complex or solid adnexal mass (no embryo, yolk sac, or tubal ring) (92%)
• intraperitoneal fluid

distinguish ectopic from corpus luteal cyst:

• less vascularity
• intra-ovarian vs para-ovarian
• surrounding follicles

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