Case 1
33-year-old female G3P1, LMP 7 weeks ago, with a history of ectopic pregnancy, which was medically managed, presenting with 1 day of vaginal bleeding. Beta-hCG 5200.
Transvaginal pelvic ultrasound showed no definitive intrauterine pregnancy and a cystic structure in the left adnexa by the ovary.
In the perinatal unit, ultrasound by MFM confirmed an ectopic pregnancy with a visible fetal heart rate. The patient underwent laparoscopy and salpingectomy that showed a dilated left fallopian tube and had a small amount of intraoperative blood loss.
Case 2
36-year-old female G4P2, LMP 3 weeks ago, presenting with lower abdominal pain after a bowel movement, followed by vaginal bleeding. Beta-hCG was 230.
Transvaginal pelvic ultrasound showed no definitive intrauterine pregnancy and a moderate to large amount of free fluid.
The patient underwent diagnostic laparoscopy with salpingectomy. 300 mL of hemoperitoneum was found intraoperatively, and the patient was diagnosed with a left ruptured tubal ectopic pregnancy.
Ectopic pregnancy on ultrasound
Approach
Start with the curvilinear probe and switch to the endocavitary probe if better resolution is needed
In a patient of childbearing age with abdominal pain and hypotension, start with a FAST exam to look for free fluid in Morison’s pouch
Findings suggestive of ectopic pregnancy
Empty uterine cavity or intrauterine fluid without a yolk sac
Abdominal free fluid
A “tubal ring” appearance, an echogenic ring that surrounds an unruptured ectopic pregnancy (n.b. this can be mimicked by a normal corpus luteum). See structure marked by arrow in image above.
Less than 5 mm of myometrium surrounding an eccentrically located gestational sac. This is a type of ectopic pregnancy called an interstitial pregnancy.
References
Happy scanning!
US team