Sonography of Obstetric and Gynecologic Emergencies
Part I, Obstetric Emergencies
Y. Kaakaji1,
H. V. Nghiem2,
C. Nodell1 and
T. C. Winter3
1
Department of Radiology, The University of Washington Medical Center, 1959
N.E. Pacific St., Seattle, WA 98195-7115.
2
Department of Radiology, University of Michigan Health System, 1500 E. Medical
Center Dr., TC2910Q, Ann Arbor, MI 48109-0326.
3
Department of Radiology, University of Wisconsin Hospital, E3/311, CSC 600
Highland AVe., Madison, WI 53792-3252.
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Fig. 1. —36-year-old woman with tubal ectopic pregnancy after artificial
insemination. Endovaginal sonogram of left adnexa shows echogenic tubal ring
(arrows) containing yolk sac (arrowhead).
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Fig. 2. —26-year-old woman with live tubal ectopic pregnancy. Endovaginal
sonogram shows live right-sided tubal ectopic pregnancy with "ring of
fire" sign of trophoblastic flow as indicated by Doppler tracing
waveform. Arrowhead points to embryo with positive cardiac activity at
real-time.
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Fig. 3A. —22-year-old woman with live right-sided tubal ectopic pregnancy.
Endovaginal sonogram shows small fluid collection within endometrium
(arrow), suggestive of intradecidual sign.
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Fig. 3B. —22-year-old woman with live right-sided tubal ectopic pregnancy.
Endovaginal sonogram of right adnexa shows extraovarian echogenic ring
(arrow) containing live embryo; corpus luteum of pregnancy is seen in
right ovary (RT OV) (arrowhead). Determination of extraovarian
location of ectopic pregnancy may be suggested by indentation seen at
interface of ovary and ectopic pregnancy or by plane of separation between
ovary and ectopic pregnancy. Rim of ovarian tissue surrounding portion of mass
would be characteristic of intraovarian location. UT = uterus.
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Fig. 4A. —Concomitant intrauterine and ectopic pregnancy in 32-year-old woman
not taking fertility drugs. Sagittal transabdominal sonogram shows
intrauterine gestation with yolk sac (arrowhead).
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Fig. 4B. —Concomitant intrauterine and ectopic pregnancy in 32-year-old woman
not taking fertility drugs. Transabdominal sonogram of right adnexa shows
tubal ring (arrows) with adjacent free fluid (ff).
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Fig. 4C. —Concomitant intrauterine and ectopic pregnancy in 32-year-old woman
not taking fertility drugs. Endovaginal sonogram of tubal ring
(arrows) in right adnexa shows that it contains embryo
(calipers), which was alive on color Doppler sonography.
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Fig. 5A. —32-year-old woman with intra abdominal pregnancy. Transverse
transabdominal sonogram shows empty uterus with thickened endometrium. Free
intraperitoneal fluid (ff) and extrauterine pregnancy is seen. Arrows point to
fetal skull.
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Fig. 5B. —32-year-old woman with intra abdominal pregnancy. Coronal
T2-weighted MR image reveals presence of empty uterus (U) and intra abdominal
pregnancy (arrow).
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Fig. 6A. —33-year-old woman with surgically proven left cornual pregnancy.
Transverse transabdominal sonogram shows echogenic ring eccentrically located
in region of left cornu (arrows).
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Fig. 6B. —33-year-old woman with surgically proven left cornual pregnancy.
Sagittal endovaginal sonogram in midline shows apparently empty uterus.
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Fig. 6C. —33-year-old woman with surgically proven left cornual pregnancy.
Oblique sagittal endovaginal sonogram oriented toward left cornu reveals
echogenic ring (arrows) with near absence of surrounding
myometrium.
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Fig. 7. —28-year-old woman with second trimester cervical incompetence.
Sagittal endovaginal sonogram shows widened endocervical canal
(calipers).
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Fig. 8A. —34-year-old woman with second trimester cervical incompetence,
emphasizing dynamic nature of cervix during pregnancy. Sagittal endovaginal
sonogram shows shortened endocervical canal (calipers), with
funneling of internal os (arrowhead).
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Fig. 8B. —34-year-old woman with second trimester cervical incompetence,
emphasizing dynamic nature of cervix during pregnancy. Second image obtained
during same examination as A reveals progressive shortening of
endocervical canal (calipers) and further widening of internal os
(arrowheads).
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Fig. 9. —Placental abruption and fetal demise in 28-year-old woman presenting
with acute pelvic pain without vaginal bleeding in early second trimester.
Endovaginal sonogram shows apparent thickening of placenta (arrow),
consistent with retroplacental hematoma. No fetal heart motion was identified.
Retroplacenta abruption may appear simply as thickened placenta.
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Fig. 10. —32-year-old woman in second trimester with placental abruption
presenting with vaginal bleeding. Sagittal transabdominal sonogram shows
thickened anterior placenta with extremely heterogeneous echo texture. Portion
of placenta closest to maternal surface (arrowheads) is much more
hypoechoic than remainder of placenta (arrows), which is more
suggestive of retroplacental abruption. After spontaneous abortion,
histopathologic examination revealed placental abruption with infarct
involving at least 50% of placenta.
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Fig. 11A. —36-year-old woman with uterine rupture after prolonged induction of
vaginal delivery. Sagittal transabdominal sonogram shows enlargement and
heterogenicity of postpartum uterus.
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Fig. 11B. —36-year-old woman with uterine rupture after prolonged induction of
vaginal delivery. Transverse image of pelvis shows complex hematoma. Complex
fluid collection and clinical symptoms suggested diagnosis. Uterine rupture
was confirmed at surgery.
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Fig. 12A. —28-year-old woman with surgically proven intraabdominal pregnancy
resulting from uterine dehiscence because anterior placenta percreta grew
anteriorly through previous cesarean scar. Sagittal endovaginal sonogram shows
empty uterus, myometrial defect anteriorly and inferiorly (long
arrows), and extrauterine pregnancy. Arrowhead points to fetal abdomen.
Short arrows indicate endometrium.
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Fig. 12B. —28-year-old woman with surgically proven intraabdominal pregnancy
resulting from uterine dehiscence because anterior placenta percreta grew
anteriorly through previous cesarean scar. Sagittal T2-weighted MR image shows
empty uterus (arrowhead) and extrauterine amniotic sac
(asterisk). Arrows indicate myometrial defect.
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Fig. 12C. —28-year-old woman with surgically proven intraabdominal pregnancy
resulting from uterine dehiscence because anterior placenta percreta grew
anteriorly through previous cesarean scar. Sagittal gradient-echo MR image
shows multiple parasitized vessels (wavy arrow) around extrauterine
pregnancy (straight arrows).
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Fig. 13A. —28-year-old woman with puerperal gonadal vein thrombosis presenting
as persistent fever 3 days after uncomplicated vaginal delivery. Sequential
axial enhanced CT images show postpartum uterus (U, A and B),
enlarged heterogeneous ovary (arrow, A), dilated tortuous
right ovarian vein with partial thrombosis (arrowhead, B), and
partial thrombosis in pararenal inferior vena cava (arrow,
C).
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Fig. 13B. —28-year-old woman with puerperal gonadal vein thrombosis presenting
as persistent fever 3 days after uncomplicated vaginal delivery. Sequential
axial enhanced CT images show postpartum uterus (U, A and B),
enlarged heterogeneous ovary (arrow, A), dilated tortuous
right ovarian vein with partial thrombosis (arrowhead, B), and
partial thrombosis in pararenal inferior vena cava (arrow,
C).
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Fig. 13C. —28-year-old woman with puerperal gonadal vein thrombosis presenting
as persistent fever 3 days after uncomplicated vaginal delivery. Sequential
axial enhanced CT images show postpartum uterus (U, A and B),
enlarged heterogeneous ovary (arrow, A), dilated tortuous
right ovarian vein with partial thrombosis (arrowhead, B), and
partial thrombosis in pararenal inferior vena cava (arrow,
C).
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Fig. 14A. —28-year-old woman with retained products of conception presenting as
persistent vaginal bleeding after spontaneous abortion. Sagittal endovaginal
color Doppler sonograms show expanded and heterogeneous endometrium
(arrowheads, A) and marked trophoblastic flow.
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Fig. 14B. —28-year-old woman with retained products of conception presenting as
persistent vaginal bleeding after spontaneous abortion. Sagittal endovaginal
color Doppler sonograms show expanded and heterogeneous endometrium
(arrowheads, A) and marked trophoblastic flow.
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Fig. 15. —30-year-old woman with retained products of conception. Sagittal
sonogram shows echogenic mass (arrowheads) expanding endometrium with
residual placental calcifications (arrow).
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Copyright © 2000 by the American Roentgen Ray Society.
