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Re: intrauterine ectopicFrom: Sharon Brown (bshabrown1@aol.com)Sat Aug 24 22:42:19 2002
At Sat, 24 Aug 2002, Martin Necas wrote: > >Dear Sharon, > >I don't think it is possible to get fetal heart tones at 6-7 weeks GA. >That's just way too early. > >>From your description, are you saying that the embryo is outside the >gestational sac and outside the endometrium... so that seems to imply >that the embryo is within the myometrium? > >A couple things that I thought of with your desciption was for example >small focal subchorionic clot pulsating with maternal heart beat. > >Usually when I see something really strange on a first trimester scan, I >would ask myself: >1) does bHCG correlate with the ultrasound findings? >2) does LMP correlate with the ultrasound findings? >3) does FH Rate correlate with CRL > >If I think I'm seeing a heartbeat, but I'm not entirely sure if it may >be from maternal pulsation or embryonic in origin, a neat trick is to >grab the patient's wrist and see if the embryonic heartbeat is different >rate. If not, it's probably transmitted pulsation from the mother. > >I hope this helps. A set of images would be great. > >Yours, > >-- >Martin Necas >RDMS, RVT > >At Fri, 23 Aug 2002, Sharon Brown wrote: >> >>I need info if posible. Last week I was sent a patient from the ER, in >>which the doc told the woman that he found fetal heart tones. I did a >>transvag and found a gestational sac with a yolk sac within. However, >>hard as I looked I couldn't find a fetal pole. As I was scanning the >>uterus I found what the doc was talking about. The problem is that the >>fetal pole that I found was outside of the gestational sac and it did >>have heart motion, it was also hyperechoic. I am completely baffeled by >>this, and the Rad that I showed the images and talked with couldn't >>quite figure it out either. How is it possible that a fetus can reach >>the 6-7 week stage outside of the gestational sac, and what would cause >>it to implant outside of the endometrious, yet still within the uterus. >>It was in the area where one would normally find a sub chorionic bleed. >>The fetal pole and the yolk sac both measured 4 mm. Any help would be >>appreciated. Thanks Sharon >
-- Thanks for your input. Hopefully I will be able to speak with the radiologist that read the scan. He wanted to do some research and said he would let me know what he found out. The motion was too fast to be that of the mother. The heart motion was discovered by the ER doc before referring the patient to me. At first I thought he was mistaken because of the empty sac, however when I did find what he was referring to I did my own testing and found heart motion a posibility in the absence of anyother logical conclusion. I am not an expert in ob and so far what I have seen has been pretty straight forward. I was unprepared for this finding. I will certainly let all know what it turns out to be if possible. again thanks for your response. Sharon
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