Advanced tubal pregnancy

The usefulness of gestational sac and placental sonographic morphology in differentiating between second‐trimester tubal and abdominal pregnancy: Case report and a review of literature

“…14 Baird et al reported a case of an unruptured tubal pregnancy at 24 weeks diagnosed during laparotomy that found a welldeveloped placenta lining the fallopian tube. 16 Conversely, in our review of abdominal pregnancy cases, the placenta was often described as irregular, mass-like, indistinct, and thin. [21][22][23][24][25][26][27] With current advanced sonographic technology, we believe it is possible to make these observations without laparotomy and arrive at the diagnosis preoperatively.…”

“…The tubal wall may eventually become imperceptible on imaging prior to rupture, as was the case in our patient. Interestingly, it has been postulated that for tubal gestations to achieve an advanced stage, it must occur along the mesosalpingeal attachment, adjacent to the ovary, because of the increased vascularity and elasticity …”

“…Interestingly, it has been postulated that for tubal gestations to achieve an advanced stage, it must occur along the mesosalpingeal attachment, adjacent to the ovary, because of the increased vascularity and elasticity. 16 In addition, at an advanced stage, the difficulty lies in differentiating whether it is tubal or abdominal. Diagnosis prior to surgery is vital because of the distinct complications and different medical management options.…”

“…In fact, reports of preoperative diagnosis of an advanced tubal pregnancy with radiologic imaging are scarce. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] They are often misdiagnosed, treated as abdominal pregnancies, and proven to be advanced tubal pregnancies after laparotomy.…”

“…However, because these cases are rarely encountered today, this may be difficult to accomplish at any one particular institution. Frequently the few images published along with the previously published case reports [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] are insufficient and the description of the imaging findings are also lacking. Review of additional images from these published reports and obtaining unpublished cases perhaps via a worldwide collaborative effort may be required to achieve statistical significance, something we believe will be difficult to achieve.…”