Re: intrauterine ectopic
From: art fougner, md (evsono@pipeline.com)
Sun Aug 25 19:05:04 2002
i agree - anecdotally first tried to date a pregnancy from a 6 wk fetal
pole only to find myself wiping the yolk off my face so to speak at 13
wks when i not surprisingly redated the pregnancy. i avoid assigning
dates until crl is at least 7 wks size. amazing how hugh robinson's
table worked out - even with the old compound b scanner.
art
At Sun, 25 Aug 2002, Allen Worrall wrote:
>
>I am of the opinion that measuring the greatest embryonic length (not
>properly called a CRL in a very early embryo) is a somewhat imprecise thing
>at 5.5-6 menstrual weeks, because it is difficult to know exactly where to
>put the cursors on a very early fuzzy embryonic pole. And MSD is not very
>precise (but can be measured more precisely than greatest embryonic length,
>since you can be pretty sure where to put the cursors when you are measuring
>the gestational sac). I feel this way despite having a very good machine,
>excellent transvaginal probe, and ability to enlarge the embryonic pole as
>much as needed.
>
>I have the feeling that gestational age may be more accurate when measured
>at 7-8 weeks, when the embryo is larger and you can see just where to put
>the cursors.
>
>Anyone have a comment pro or con?
>
>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: "Terry J DuBose" <tjdubose@juno.com>
>To: "Multiple recipients of list ULTRASOUND"
><ultrasound@mail.medispecialty.com>
>Sent: Sunday, August 25, 2002 9:52 AM
>Subject: Re: intrauterine ectopic
>
>> 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
>> >
>>
--
art fougner, md
ich bin ein New Yorker
