Hemorrhagic Contents Within Uterine Sac Mimicking Intrauterine Pregnancy on Point-of-Care Ultrasound: A Case Report of a Ruptured Ectopic Pregnancy.
We present a case of a female patient who presented to the emergency department with
lower abdominal pain and was found to have a ruptured ectopic pregnancy with hemorrhagic
uterine contents mimicking a fetal pole on bedside transabdominal point-of-care ultrasound. The case
reinforces the importance of accurately interpreting the transabdominal pelvic POCUS for potential mimics of an intrauterine pregnancy.
In addition, the case also emphasizes the performance of an abdominal ultrasound
for free fluid assessment in the right and left upper quadrants to evaluate for free
fluid in patients with concerns for a ruptured ectopic pregnancy.
The importance of timely diagnosis of ectopic pregnancy cannot be understated. The incidence
of ectopic pregnancy in the general population is approximately 2%. The prevalence of
ectopic pregnancy in the emergency department patient population is estimated around 8%.
Ruptured ectopic pregnancy comprises a significant proportion of these cases. Risk factors
for ectopic pregnancy include previous ectopic pregnancy, pelvic inflammatory disease,
Chlamydia trachomatis infection, prior intrauterine surgeries, tubal surgery, fertility treatment,
endometriosis and smoking.
Ruptured ectopic pregnancy also comprise a significant proportion of
maternal death. The diagnosis of an ectopic pregnancy is primarily
by US, which can rapidly be
evaluated by the Emergency Physician at the bedside. The presence of an intrauterine
gestational sac with yolk sac or fetal pole rules out an ectopic pregnancy unless, in rare cases,
a heterotopic pregnancy is present.
Emerg Med Open J. 2016; 2(1): 11-14. doi: 10.17140/EMOJ-2-121
