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A 29-year-old gravida 10, para 3 (1 term gestation, 1 preterm gestation of twins, 1 stillbirth at 5 months, 2 spontaneous abortions, and 4 elective abortions) presented to the clinic at about 5 weeks’ gestation with abdominal pain and vaginal bleeding. Dr Pippitt is a visiting instructor and Dr Stoesser is assistant professor both in the department of family and preventive medicine at University of Utah School of Medicine. As a busy clinician, balancing work life and home life and personal time generally means that something gives. There is a tongue of placental tissue (Red Arrow) which is overlying the internal os of the cervix (Asterix). Endocervical canal leading up to internal os of an engorged cervix (asterix), endocervical stroma present (between White Arrows). The myometrium is thinned (White Arrows), the placenta invades through the full thickness of myometrial wall (Yellow Arrows) and anterior surface of the bladder wall (Blue Arrow). 41 year old patient, 28 days post partum MRI obtained for monitoring after placenta percreta left in situ. High signal intensity on T2WIs; this is liquefaction of placental tissue which then fills with blood representing placental lakes (Red Arrows).
Low lying placenta identified on routine antenatal sonography and referred for MRI to exclude invasive placenta. The lower anterior margin of the placenta is invading the myometrium (Yellow Arrows) but does not breach the full thickness of the myometrial muscle; MRI findings are consistent with a placenta praevia and placenta accreta.
The internal os (Asterix) and external os (Blue Arrow) of the cervix is open and there is soft tissue and haemorrhage within the dilated vaginal vault (White Arrows).
Patient required bilateral iliac artery embolisation which obviated hysterectomy following a postpartum haemorrhage. MRI findings consistent with a placenta praevia and placenta percreta with cervical and bladder wall invasion. If there is deep invasion of the placenta or uncontrollable post partum haemorrhage the placenta can be left in situ and gradual resorption can occur.
Myometrial thinning (Blue Arrow) with placenta invading through the full thickness of the myometrium (Yellow Arrow).

The endometrial cavity is distended with intermediate signal within it representing blood (Red Arrows).
The placenta is now heterogeneous (White Arrows) and low signal intensity (Red Arrows) compared to intermediate signal previously consistent with persistent involution.
Placenta (P) reduced in volume but still in situ overlying internal os of cervix (Asterix). 2 clicks for more privacy: On the first click the button will be activated and you can then share the poster with a second click.
Weighing in at around 2 to 2? ounces or 60 to 70 grams and measuring around 4 inches or 10 cm, baby is about the size of an orange. Your uterus is now starting to grow up and out of your pelvis, so you may have a just noticeable bump! You finally look pregnant! Try using pillows to prop you up or behind your knees, make sure the air temperature is comfortable or invest in a body pillow. Adapting your clothing to your growing waistline can be done by investing in a belly band, enabling you to continue wearing some of your favorite tops.
She described the pain as sporadic, mostly on the left side, exacerbated by movement, and resolving with rest, and the bleeding as initially intermittent but then heavier “like a period.” Abdominal and bimanual findings were normal.
The placenta is heterogeneous with flow voids, which are low signal intensity on T2 (Yellow Arrows). Uterine bulge visible along the left lateral aspect (Yellow Arrows) raising the possibility of an invasive placenta.
Although there’s no one-size-fits-all approach to pregnancy weight gain, use healthy lifestyle habits to manage your pregnancy weight gain.
Recurrent chlamydial infections increase the risks of hospitalization for ectopic pregnancy and pelvic inflammatory disease. Rare association of ovarian implantation site for patients with heterotopic and with primary ectopic pregnancies after ICSI and blastocyst transfer.
Low lying placenta diagnosed on routine antenatal sonography, high suspicion for accreta therefore MRI obtained.

A low lying placenta (P) completely covers the internal cervical os and the anterior isthmic portion of the uterus, in keeping with placenta praevia. First time pregnancy can make you feel like you have been in a tumble-drier emotionally with highs and lows, but it is worth it when you see your newborn miracle. Patient had prophylactic uterine artery embolisation, however had uterine rupture during delivery with post partum hemorrhage and required a total hysterectomy. The placenta was left in situ, over the series of four images the placenta can be seen undergoing gradual involutional change and resorption. HETEROTOPIC PREGNANCY: AN OVERVIEW Heterotopic pregnancy (HP) is the existence of 2 (or more) simultaneous pregnancies with separate implantation sites, one of which is ectopic.
Ledoux began her career as an ObGyn nurse practitioner prior to becoming a practicing midwife in the Santa Cruz community. Working together with ObGyn physicians in her own practice, she has over 20 years experience in women's health, pregnancy and childbirth.
In a review of 66 cases of combined intrauterine and extrauterine gestations, abdominal pain alone was found to be the most common presenting symptom of HP.8 The combination of lower abdominal pain, an adnexal mass, peritoneal irritation, and an enlarged uterus most strongly supported the existence of HP. The main concern in this patient, with her continued vaginal spotting and known IUP, was threatened abortion.
However, an EP can also have a normal hCG rise.12 In a normal spontaneous gestation, once an IUP has been identified, hCG levels are typically unnecessary. This patient underwent emergent laparoscopy; however, because of a large hemoperitoneum, open laparotomy was necessary.
This revealed a rupture in the middle third of the right fallopian tube; the entire tube was edematous and ecchymotic.

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