Pitfalls in emergency department focused bedside sonography of first trimester pregnancy

Abstract

Background. Bedside sonography performed by emergency physicians is frequently utilized for real-time clinical decision-making in the emergency department (ED) setting. This includes the sonographic evaluation of pain or bleeding in the first trimester of pregnancy. The detection of intrauterine pregnancy (IUP) or life-threatening conditions, including ectopic pregnancy, is critical. Objectives. This paper will review several important pearls and avoidable pitfalls of this diagnostic modality by brief presentation of illustrative cases followed by discussion of key principles. Case Reports. Three patients evaluated in the ED for bleeding or pain occurring during the first trimester of pregnancy will be presented. Conclusions. When conducting emergency bedside ultrasound for the evaluation of first trimester pregnancy, it is important to avoid common pitfalls that can place your patient at risk.

Figure 1

Utilizing a 5–8 MHz Sonosite intracavitary transducer, an empty uterus is noted. Posterior to the uterus, there is a region of hypoechoic fluid visualized (arrowheads).

Figure 2

Utilizing a Sonosite C60 2–5 MHz curvilinear transducer, this transabdominal ultrasound image displays an empty uterus with a thin sliver of hypoechoic fluid posterior to the uterine wall (arrow).

Figure 3

Pelvic ultrasound demonstrates the same hypoechoic fluid collection posterior to the uterine wall seen on transabdominal ultrasound in Figure 2.

Figure 4

Pelvic ultrasound (long view, right adnexa) demonstrates a fluid collection of mixed echogenic and anechoic material surrounding the right ovary.

Figure 5

Pelvic ultrasound demonstrates a right adnexal mass (labeled RT ADN) adjacent to the uterus (labeled UT) with surrounding hypoechoic fluid suspicious for ectopic pregnancy.