Pregnancy known fallopian tube scarring with

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pregnancy, known fallopian tube scarring) with unacceptably high rates of heterotopic pregnancy who should also always undergo formal sono- graphy and consultation, but this recommendation is not universally followed. Diagnostic ultrasound 91 First trimester ultrasound
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Focused questions for first trimester ultrasound The questions for first trimester ultrasound are as follows: 1. Is there an intrauterine pregnancy? a. Is there an intrauterine yolk sac, fetal pole, or fetal heartbeat? b. Anything else (including an intrauterine gestational sac) is not an intrauterine pregnancy, and a formal study or a formal consultation should be performed. In addition, female patients of child-bearing age who present with atraumatic abdominal pain and shock should always undergo a FAST exam to evaluate for abdominal hemorrhage. In this patient population a positive FAST should prompt treatment and resuscitation for ruptured ectopic pregnancy. Terminology Terminology used when describing first trimester pregnancy can be confus- ing, and it is important that emergency physicians are precise when describ- ing their findings. Miscommunication can lead to emotional distress and unsafe assumptions. The following list defines terms commonly used in first trimester pregnancy: ± Spontaneous abortion and miscarriage – synonymous terms in early pregnancy that refer to spontaneous passage of the products of concep- tion (POC) through the cervical os. ± Threatened abortion – a pregnancy prior to 20 weeks of gestation accompanied by cramping and vaginal bleeding. ± Incomplete abortion – a condition in which some POC remain within the uterus after miscarriage. ± Complete abortion – a condition in which all POC have passed through the os and none remain in the uterus. ± Inevitable abortion – a condition in which the patient’s cervix is dilated and POC are often seen exiting the cervical os. ± Missed abortion – refers to the clinical situation in which an intra- uterine pregnancy is present but no longer developing normally. The gestation is termed a missed abortion only if the diagnosis of incomplete abortion or inevitable abortion is excluded. Patients with this condition may present with an anembryonic gestation (empty sac or blighted ovum) or with fetal demise prior to 20 weeks’ gestation. ± Blighted ovum – an ambiguous term that formerly indicated that no embryo ever developed. This term was synonymous with 92 Diagnostic ultrasound First trimester ultrasound
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the term anembryonic gestation . Recent advances in ultrasound scanning have shown that a very early embryo usually develops. Therefore, embryonic resorption has become the more modern and appropriate term. ± Embryonic demise – refers to a pregnancy in which no fetal heartbeat or motion is seen despite a clearly visible embryo of a gestational size where a fetal heartbeat would be expected.
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