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582 I. Zalud<br />

Fig. 39.20. Ipsilateral corpus luteum<br />

shows significantly higher impedance<br />

to blood flow (RI=0.52) and can be distinguished<br />

from signals obtained from<br />

the periphery of the gestational sac<br />

Fig. 39.21. Ectopic gestational sac in<br />

the left adnexal region surrounded by<br />

a ªring of fireº (nearby vessels)<br />

Other Types of Ectopic Pregnancy<br />

Interstitial/Cornual Pregnancy<br />

These two terms are used interchangeably, though<br />

strictly speaking the term cornual pregnancy should<br />

be reserved for pregnancy in a rudimentary uterine<br />

horn. Only 2%±4% of ectopic pregnancies develop in<br />

the interstitial portion of the fallopian tube [38]. The<br />

surrounding myometrium permits the pregnancy to<br />

progress to an advanced age (12±16 weeks) before it<br />

ruptures. Severe hemorrhage ensues leading to a significantly<br />

higher mortality and morbidity.<br />

High-resolution ultrasound along with the color<br />

flow Doppler equipment enables an early and accurate<br />

diagnosis to be made. Sonographic findings include eccentric<br />

location of the gestational sac and myometrial<br />

thinning. Ackerman et al. have described the ªinterstitial<br />

lineº sign in cases where the visible myometrium<br />

completely surrounds the gestational sac, making the<br />

diagnosis difficult. They proposed that since interstitial<br />

pregnancy grows within the lumen of the tube, the endometrial<br />

cavity or interstitial portion of the tube can<br />

be traced directly to the eccentric gestational sac. This<br />

sign was reported to be 80% sensitive and 99% specific<br />

for the interstitial pregnancy [39].

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