Ruling out Ectopic Pregnancy
When to Scan:
Patients presenting with a positive pregnancy test and:
- Vaginal bleed in 1st trimester
- Abdominal pain in 1st trimester
- Shock or hypotension in 1st trimester
Transabdominal Approach:
- Best with full bladder
- Don't forget to change exam setting to OB
Where to put the probe:
• Midline in longitudinal and transverse planes
• Just cephalad to pubic symphysis
• Identify the bladder and then uterus next to the bladder
• Sweep through entire uterus in both longitudinal and transverse planes
Transvaginal approach (best with empty bladder):
• Probe marker to ceiling in sagittal plane
• Probe marker to patient right in coronal plane
• Identify the uterus and sweep through the uterus in both sagittal and longitudinal planes
When to Scan:
Patients presenting with a positive pregnancy test and:
- Vaginal bleed in 1st trimester
- Abdominal/pelvic pain in 1st trimester
- Shock or hypotension in 1st trimester
Transabdominal Approach:
- Best with full bladder
- Don't forget to change exam setting to OB
• Midline in longitudinal and transverse planes
• Just cephalad to pubic symphysis
• Identify the bladder and then uterus next to the bladder
• Sweep through entire uterus in both longitudinal and transverse planes
Transvaginal approach (best with empty bladder):
• Probe marker to ceiling in sagittal plane
• Probe marker to patient right in coronal plane
• Identify the uterus and sweep through the uterus in both sagittal and longitudinal planes
Findings
If concerned for ectopic pregnancy, add RUQ or FAST scans.
Exercise caution when declaring positive IUP. Be mindful of false positive scans.
Intrauterine pregnancy (IUP):
• Bladder uterine juxtaposition
• Decidual reaction
• Gestational sac and yolk sac and/or embryo with fetal heart rate completely surrounded by myometrium
No Definitive IUP (NDIUP):
• Must have bladder uterine juxtaposition, gestational sac, and yolk sac and/or embryo with fetal heart rate
• Otherwise scan is non-determinate
Transvaginal IUP:
