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ECCU
Tuesday, 19 November 13
OBJECTIVES
Review the normal ultrasound anatomy of the female pelvis. Demonstrate features of a normal 1st trimester pregnancy. Discuss the utility of ultrasound in the diagnosis of ectopic pregnancy.
Tuesday, 19 November 13
CASE
HAND OVER: 28 yr old female presents with abdominal cramping for three hours vomiting and diarrhea. Used cocaine and dilaudid IV last 6 hours ago. Off to XRay?? HR 100 BP100/80 RR 20 SaO2 100% RA T 37.8 G0 P0. LMP 4 weeks ago. No PV bleeding. PMHx nil. Abdomen soft, minimally tender RLQ. Pelvic exam normal except slight tenderness RLQ.
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CASE
Positive!
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ANATOMY
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US PELVIC ANATOMY
Trans-Abdominal
Low frequency probe for penetration Full bladder
Trans-Vaginal
High frequency probe for resolution Empty bladder
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TA TRANSVERSE VIEW
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TRANS-VAGINAL ANATOMY
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Gestational Sac TV ~ 5 wk TA ~ 6 wk
Fetal Pole TV ~ 6 wk TA ~ 7 wk
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GESTATIONAL SAC
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GESTATIONAL SAC
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YOLK SAC
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YOLK SAC
FETAL POLE
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CARDIAC ACTIVITY
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ECTOPIC PREGNANCY
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ECTOPIC PREGNANCY
Is there an IUP?
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ECTOPIC PREGNANCY
Is there an IUP? Is there an ectopic pregnancy?
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ECTOPIC PREGNANCY
Is there an IUP? Is there an ectopic pregnancy? Is there free fluid in the pelvis?
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An empty uterus above these levels is suspicious for an ectopic (or non-viable).
No IUP and large amount free uid - presume ruptured ectopic
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An empty uterus above these levels is suspicious for an ectopic (or non-viable).
No IUP and large amount free uid - presume ruptured ectopic
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An empty uterus above these levels is suspicious for an ectopic (or non-viable).
No IUP and large amount free uid - presume ruptured ectopic
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Unstable patient
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CASE
Tuesday, 19 November 13
CASE
BP 80/60, HR 120 shortly after ultrasound. Patient was resuscitated with IVF and pRBCs. Obstetrics was consulted STAT and the patient was taken immediately to the OR for ruptured ectopic pregnancy. Patient survived with no adverse outcome.
Tuesday, 19 November 13
CONCLUSION
On trans-abdominal ultrasound, the uterus is identified by its location adjacent to the bladder and the endometrial stripe. The early diagnosis of an IUP requires visualization of the yolk sac and/or fetal pole within the uterine myometrium. An IUP essentially rules-out an ectopic pregnancy if the patient did not undergo assisted reproduction.
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PELVIC ULTRASOUND
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