The IOW this week comes from Drs Balusu, Wallace, and O'Donnell, who used the ultrasound to identify an ectopic pregnancy using bedside ultrasound. Their patient was a young female thought to be approx 8 weeks pregnant who presented with generalized abdominal pain. She was hemodynamically stable. The ultrasound below was obtained with a curvilinear probe placed just superior to the pubic symphysis with the indicator marker pointed towards the patient's head. Note that on this image no definitive intrauterine pregnancy is identified. Recall that an intrauterine pregnancy is defined and a gestational sac containing either a yolk sac or a fetal pole surrounded by a thick rim of the myometrium. It is important that you identify contents within the gestational sac as pseudo sac can form in association with an ectopic pregnancy that may be incorrectly identified as a true IUP.
Image 1
As they continued to fan the probe, they were able to locate the ectopic pregnancy in the left adnexal region. A gestational sac with a fetal pole, yolk sac, and cardiac activity was identified outside the uterus.
Image 2
Given the size of the ectopic, the presence of significant free fluid suggestive of rupture, and the presence of fetal cardiac activity, this patient required operative therapy. She underwent laparoscopy, salpingectomy, and removal of her ectopic. In the OR 900ccs of hemoperitoneum was removed.
To see a video of this great scan with fetal cardiac activity outside of the uterus see case video below.
Date: October 2014