Re: intrauterine ectopic
From: Allen Worrall (jworrall@alaska.net)
Sun Aug 25 03:23:39 2002
Martin is of course correct that one cannot auscultate the fetal heart at
6-7 weeks. I assumed after I read the message that the "doc who told the
woman he found fetal heart tones" meant that he had seen a fetal heart
beat with ultrasound. Even with a continuous wave fetal heart rate device I
have never been able to hear the fetal heart at 7 weeks. ( weeks yes).
I am totally puzzled by the description. If I understand correctly, the
embryo was in the subchorionic space. At this stage the embryo and the yolk
sac are still very closely adjacent to each other. Maybe this was
dichorionic twins with an unusual appearance?
Good to hear from you Martin.
Allen
Joseph A Worrall MD RDMS
OB/GYN Ultrasound at the Fairbanks Clinic
Fairbanks, Alaska, USA
jworrall@alaska.net
http://www.obgynsono.com
>----- Original Message -----
From: "Martin Necas" <exiled@clear.net.nz>
To: "Multiple recipients of list ULTRASOUND"
<ultrasound@mail.medispecialty.com>
Sent: Saturday, August 24, 2002 2:12 PM
Subject: Re: intrauterine ectopic
> 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
>
