29 yo F G2P0010 at about 10 weeks 3 days gestation by LMP presented for 2 weeks of intermittent vaginal bleeding, now with 2 days of right sided lower abdominal pain and pre-syncope. On exam, the patient was mildly tachycardic, but otherwise hemodynamically stable and had tenderness in the right lower abdomen without guarding.
Bedside transabdominal ultrasound was performed. What is the diagnosis and how must the patient be managed?
Answer: ectopic pregnancy
The videos show:
-an empty uterus with thickened endometrial stripe
-an adjacent right sided ectopic pregnancy with a live fetus that later measures 11 weeks 1 day gestation
-the appearance of complex fluid within the rectouterine pouch
In the first half of the video, it may be tempting to see a large fetus with surrounding echogenic material and be falsely reassured. But when further views are obtained, it becomes obvious that this gestation is distinct from the endometrial cavity, in this case, within the right fallopian tube.
This patient should be managed with resuscitation, as needed, and prompt OB-GYN consultation for surgical removal of the ruptured ectopic pregnancy.
-Allison Zanaboni, MD, Emergency Medicine Ultrasound Fellow