Re: intrauterine ectopic
From: Terry J DuBose (tjdubose@juno.com)
Sun Aug 25 12:50:51 2002
Dr. Fougner, I agree... I have also seen EHRs at 1 mm... correlates to
about 5.0 weeks after LMP and a mean EHR of of 94 B/M (my table 7-5,
Fetal Sonography, 1996. The heart rate will usually accelerate at a rate
of 3.3 beats per minute per day from when it is first detected until a
CRL of 2.6-2.8 mm or 9.2 weeks before beginning a deceleration from a
peak of about 189 B/M at 9.2 weeks (+/-1 to 2 days). The EHR time series
curve has the shape of a classic damping feed-back curve.
Dr. Ronald Shats, Amsterdam 1991, TV Sonography in Early Human Preg. said
that if you see cardiac activity you are seeing the embryonic pole. He
also indicated that one of the problems in getting an exact age is there
appears to be a variation in time of first heart beating due to
variations in implantation times. On page 39 of his dissertation that
"References to days are given only as guidelines and thus are
approximations of the truth because early stages of implantation of the
human blastocyst have not been observed. Most knowledge about early
implantation is based on studies of the Rhesus monkey, but the process is
thought to be essentially similar to man."
Sonography has given us a very early window on embryonic development.
The correlation of the CRL, EHR, and hCG have not been thoroughly studied
and are not well understood. We have gotten to within about 3 days of a
"true" date, but can't seem to resolve it more than that.
One of the most interesting questions in human development, IMHO.
Peace, Terry J DuBose, M.S., RDMS
Little Rock, Arkasas USA
On Sun, 25 Aug 2002 11:08:06 -0500 evsono@pipeline.com (art fougner, md)
writes:
> Martin -
>
> have seen as Terry so fondly calls it - embryonic cardiac activity
> with
> 1 mm fetal poles using 7 - 8 Mhz frequency vaginal transducers.
>
> Sharon -
>
> have seen for want of a better term - intra-amniotic yolk sacs twice
> -
> both pregnancies ended in spontaneous Ab. wonder if your findings
> could
> represent the early appearance of the extrachorial gestation? do
> you
> have images? i sense a case report.
>
> art
>
> At Sat, 24 Aug 2002, Sharon Brown wrote:
> >
> >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
> >
> >I will try to get permission to upload a couple of images. At this
> point I
> >don't know what to think.
> >
>
> --
> art fougner, md
> ich bin ein New Yorker
>
