scholarly journals The Use of Transvaginal Ultrasound by Emergency Physicians in Medical Student Education

2009 ◽  
Vol 3 (4) ◽  
pp. 59-64
Author(s):  
Nadah B Zafar ◽  
Veronica Greer ◽  
Robert H Woolard
Keyword(s):  
Medical Student ◽  
Transvaginal Ultrasound ◽  
El Paso ◽  
Lower Abdominal Pain ◽  
Medical Student Education ◽  
First Trimester ◽  
Emergency Physicians ◽  
Pregnancy Test ◽  
Positive Pregnancy Test ◽  
Texas Tech University

Abstract Paul L Foster School of Medicine at Texas Tech University Health Sciences Center in El Paso offers the students a faculty (both clinician and basic scientists) guided clinical presentation based curriculum. Emergency physicians have been an integral part of this curriculum. Bedside transvaginal ultrasound has become an adjunct to the history and physical examination for the evaluation in a timely manner of acute pelvic and lower abdominal pain and vaginal bleeding in the female of reproductive years. Discussion of the approach to diagnosis is divided into two broad categories; evaluation when there's a positive pregnancy test (first trimester) and a negative pregnancy test. The discussion also illustrates how the emergency physician can, using ultrasound, introduce, integrate, and review, the pertinent basic sciences (anatomy, embryology, pathology, physiology, microbiology and biochemistry) with the medical student.

scholarly journals Normal and Abnormal Early Pregnancy

2011 ◽  
Vol 5 (4) ◽  
pp. 356-384
Author(s):  
Giovanni Monni ◽  
Ulrich Honemeyer
Keyword(s):  
Early Pregnancy ◽  
Color Doppler ◽  
Transvaginal Ultrasound ◽  
Lower Abdominal Pain ◽  
Fetal Life ◽  
Intrauterine Pregnancy ◽  
Pregnancy Test ◽  
Beta Hcg ◽  
Positive Pregnancy Test ◽  
Pregnancy Disorders

ABSTRACT The first trimester, mostly defined as the first 100 days of pregnancy, is characterized by many important landmarks heralding the ultimate outcome of pregnancy. Woman becomes aware of her pregnancy after missing her period, being already two weeks postconception at that time. A positive pregnancy test opens Pandora's Box, raising more questions than giving answers. Although a positive pregnancy test most likely suggests an intrauterine pregnancy, production of human chorionic gonadotropin (hCG) occurs as well in tumors (dysgerminoma, choriocarcinoma) or maldeveloped pregnancies, such as ectopic pregnancy, blighted ovum or mola hydatidosa. Other early pregnancy complications and failures, like subchorionic hematoma, missed abortion, incomplete miscarriage, retained products of conception, are likely to be accompanied by clinical symptoms such as lower abdominal pain and/or vaginal bleeding, and suboptimal beta hCG serum levels. Transvaginal ultrasound probes with frequencies of up to 14 MHz have lowered the threshold for US-detection of intrauterine pregnancy to 1200 mIu/ml beta hCG/serum (discriminatory zone), and enable identification of all above-mentioned 1st trimester pregnancy disorders earlier than ever before. Furthermore, the additional interrogation of the region of interest (ROI) with color Doppler (CD) and pulsed-wave Doppler (PW) supplies important information about characteristics of vascularization and flow indices, which assists in further differentiation and prognosis of abnormal early pregnancy findings. With the introduction of transvaginal three-dimensional (3D) sonography, and real-time 3D ultrasound (4D), in vivo studies of the early fetal life became possible. The developmental progress of the embryo and early fetus, its anatomy, and first movement patterns, have been explored by means of ultrasonic 3- and 4D imaging, which can be considered as nonteratogenic as long as investigators adhere to certain safety rules. The new field of sonoembryology has emerged, and researchers are penetrating the mists hiding the beginning of human life. Another area of remarkable expansion has been the 1st trimester scan between 11 and 13/6 weeks of gestation. It includes not only the early diagnose of fetal structural anomalies, like acranius-anencephalus sequence, and the screening for fetal aneuploidies such as trisomia 21,18 and 13, but also offers likelihood ratios for hypertensive pregnancy disorders (pre-eclampsia) and intrauterine growth restriction (IUGR).

scholarly journals Negative βhCG and Molar Pregnancy: The Hook Effect

2017 ◽  
Vol 30 (9) ◽  
pp. 656
Author(s):  
Isabel Lobo Antunes ◽  
Joana Curado ◽  
Ana Quintas ◽  
Alcides Pereira
Keyword(s):  
Transvaginal Ultrasound ◽  
Delayed Diagnosis ◽  
Gestational Trophoblastic Disease ◽  
Reproductive Age ◽  
Molar Pregnancy ◽  
Pregnancy Test ◽  
Hook Effect ◽  
Benign Pathology ◽  
Positive Pregnancy Test ◽  
High Index Of Suspicion

Molar pregnancy, included in gestational trophoblastic disease, is a benign pathology with ability to metastasize, usually occurring with excessively high βhCG levels. Clinical scenario is usually a woman in extremes of reproductive age presenting with amenorrhoea, pain and vaginal blood loss; signs derived from high βhCG levels may be present (hyperthyroidism, hyperemesis). Diagnosis is based on a positive pregnancy test – usually a qualitative urinary test. The limitation of this test results from its inability to become positive in presence of markedly high levels of βhCG, saturating the antigens used – known as the ‘hook effect’. With the widespread use of gynaecological ultrasound cases of molar pregnancy have been diagnosed in timely fashion. We describe a case referred as a degenerating fibroid, with a negative urinary pregnancy test. Transvaginal ultrasound was highly suggestive of molar pregnancy, which was confirmed with a quantitative βhCG test, allowing for timely treatment. The importance of a high index of suspicion for this pathology is tremendous to avoid the devastating consequences of a delayed diagnosis.

scholarly journals Ruptured Unilateral Twin Tubal Ectopic Pregnancy. Case Report of an oddity & Literature Review

2020 ◽  
Vol 1 (1) ◽  
pp. 60-63
Author(s):  
Palwasha Gul ◽  
Khanda Gul ◽  
Pari Gul ◽  
Tanzila Parveen
Keyword(s):  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Uterine Cavity ◽  
Lower Abdominal Pain ◽  
Exploratory Laparotomy ◽  
First Trimester ◽  
Maternal Deaths ◽  
Tubal Ectopic Pregnancy ◽  
Beta Hcg ◽  
Ectopic Pregnancies

Background: An ectopic pregnancy (EP) is a type of conception in which, the fertilized egg is lodged outside the uterine cavity. Twin ectopic pregnancies are a rarity, and the reported cases of twin tubal pregnancies are a handful to date.Case Report: We report a case of a 35 years old patient who presented to the emergency with the complaint of lower abdominal pain and intermittent vaginal discharge. She was diagnosed with twin tubal alive gestation, underwent exploratory laparotomy and right salpingectomy.Conclusion: Ectopic pregnancy can occur even in the absence of known risk factors. Its incidence is on the rise. It is a leading cause of first-trimester maternal deaths and can be easily diagnosed with Beta HCG levels and transvaginal ultrasound.

scholarly journals CHALLENGE FOR THE GYNECOLOGIST - CASE OF TUBAL ABORTION

2020 ◽  
Vol 1 (1) ◽  
pp. 7-11
Author(s):  
Aida Petca ◽  
Alina Stan ◽  
Florica Sandru ◽  
Razvan Petca ◽  
Mihai Cristian Dumitrascu
Keyword(s):  
Fallopian Tube ◽  
Transvaginal Ultrasound ◽  
Clinical Status ◽  
Fluid Collection ◽  
Lower Abdominal Pain ◽  
Invasive Procedure ◽  
Internal Bleeding ◽  
Positive Pregnancy Test ◽  
Serial Serum ◽  
Β Hcg

Tubal abortion represents a rare entity in the gynecology practice, defining an ectopic pregnancy with the gestational sac situated in the peritoneal cavity, consequence of the extrusion from the fallopian tube through the terminal ostium. It often complicates with severe internal bleeding causing acute surgical abdomen. The diagnosis is frequently difficult and relies on a combination of ultrasound scanning, serial serum beta-human chorionic gonadotrophin (β-hCG) measurements, whilst observing the clinical status of the patient. We present the case of a 27 years-old woman admitted for lower abdominal pain, having a positive pregnancy test. The level of β-hCG was 1185 mU/mL and transvaginal ultrasound revealed a fluid collection in the pouch of Douglas, an empty uterus and an adnexal mass image of 22/14mm. At first, medical management was preferred, a single dose regimen of Metotrexat was administered. 48 hours later, as the symptoms became more evident and the collection in the Douglas pouch increased, diagnostic laparoscopy was performed. The diagnosis of complete tubal abortion was evident based on sonographic findings, the β-hCG dynamics and the laparoscopic features. Preserving the implicated fallopian tube through a minimally invasive procedure allowed the patient’s rapid recovery and a short hospital stay.

Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

2020 ◽  
Vol 16 ◽  
Author(s):  
Divya Mirji ◽  
Shubha Rao ◽  
Akhila Vasudeva ◽  
Roopa P.S
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Management Strategy ◽  
Transvaginal Ultrasound ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Β Hcg ◽  
Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

scholarly journals Novel coronavirus, novel faculty development programs: rapid transition to eLearning during the pandemic

2020 ◽  
Vol 48 (5) ◽  
pp. 446-449 ◽  
Author(s):  
Zuber D. Mulla ◽  
Valerie Osland-Paton ◽  
Marco A. Rodriguez ◽  
Eduardo Vazquez ◽  
Sanja Kupesic Plavsic
Keyword(s):  
Online Education ◽  
Faculty Development ◽  
El Paso ◽  
Health Centers ◽  
Academic Health Centers ◽  
The Novel ◽  
Development Programs ◽  
Rapid Transition ◽  
Texas Tech University ◽  
Novel Coronavirus

AbstractThe novel coronavirus disease 2019 (COVID-19) has caused a rapid and massive transition to online education. We describe the response of our Office of Faculty Development at Texas Tech University Health Sciences Center El Paso (TTUHSC EP) to this unprecedented challenge during and after this post-pandemic crisis. The initiatives for emergency transition to eLearning and faculty development described in this paper may serve as a model for other academic health centers, schools, colleges and universities.

scholarly journals Lung neoplasm mimicking as ectopic pregnancy due to paraneoplastic secretion of human chorionic gonadotropin: a case report and literature review

2021 ◽  
Author(s):  
Jin Peng ◽  
Shangge lv ◽  
Lin Liu ◽  
Shuai Feng ◽  
Naidong Xing
Keyword(s):  
Systematic Review ◽  
Ectopic Pregnancy ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Lung Neoplasm ◽  
High Serum ◽  
Pregnancy Test ◽  
Positive Pregnancy Test ◽  
Β Hcg ◽  
Present Systematic Review

Abstract Purpose The present systematic review aimed to examine the relationship between lung neoplasm and human chorionic gonadotropin (HCG). Especially, women with lung neoplasm mimicking as ectopic pregnancy were explored. Methods A rare case of lung neoplasm with high serum β-HCG, which was initially thought to be ectopic pregnancy, was reported. A literature search was performed of the US National Library of Medicine (MEDLINE), EMBASE, PubMed, and the Cochrane Database of Systematic Reviews using appropriate keywords and subject headings to February 2020. Results Studies assessed lung neoplasm patients with positive HCG were included. Twenty studies, including 24 patients, were included. These cases illustrate the importance of considering the possibility of paraneoplastic secretion of β-HCG in patients who have a positive pregnancy test. This may prevent a delay in the diagnosis and treatment of malignancy in young women. Of the 24 cases, only 7 (29.17%) were managed surgically; others were managed conservatively or with chemotherapy or radiation. Conclusion The present systematic review shows the need to re-awaken awareness and high index of suspicion to lung neoplasm diagnosis in patients with positive pregnancy test.

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