Ectopic Pregnancy

This week’s images are brought to us by Drs. Nicole Franks and Ruth Lamm, who both independently made the bedside diagnosis of ectopic pregnancy using different ultrasonographic images. 

The first image is a right upper quadrant FAST image that shows us the presence of free fluid in Morrison’s pouch.   

 

In a patient with suspected ectopic pregnancy this finding predicts the need for operative intervention (see reference).  This should be the first place you scan in a patient with suspected ectopic pregnancy.  

Our second patient did not have significant intraperitoneal blood, but was also diagnosed with an ectopic.  The first image was obtained using the curvilinear probe with the indicator towards the patient’s head. We can see the uterus just posterior to the bladder without an identifiable intrauterine pregnancy (IUP.) 

Scanning through the pelvis a cystic mass likely representing the ectopic was seen in the right adnexa. 

 

Remember you do not need to find the ectopic on ultrasound.  As emergency providers, our goal is to identify an IUP. If we cannot, and the BHCG is positive, the patient has an ectopic until proven otherwise. 

Reference:

Free fluid in Morison's pouch on bedside ultrasound predicts need for operative intervention in suspected ectopic pregnancy.

Moore C, Todd WM, O'Brien E, Lin H.

Acad Emerg Med. 2007 Aug;14(8):755-8. Epub 2007 Jun 6.

PMID:17554008 [PubMed - indexed for MEDLINE]