0071643192.pdf

OBSTETRICS AND GYNECOLOGY

■ Culdocentesis (placement of a needle through the posterior wall of the
vagina to aspirate blood in the cul-de-sac) is rarely performed. It is indi-
cated only in settings where sonography is not available, and ruptured ec-
topic is suspected. Aspiration of nonclotting blood is considered positive
and indicative of an ectopic pregnancy (see Table 12.1).

FIGURE 12.2. Endovaginal ultrasound with the uterus in the upper left side and an
ectopic pregnancy on the right with a fetal pole.

(Reproduced, with permission, from Plantz SH, Collman D, Gossman WG, et al. Emergency
Medicine Written Board Review, 6th ed.McGraw-Hill, 2006:446.)

TABLE 12.1. Ultrasound Findings in Suspected Ectopic Pregnancy

IUP ECTOPIC SUGGESTECTOPIC INDETERMINATE

Yolk sac within a Ectopic fetal pole Fluid in the cul- Empty uterus

gestational sac de-sac with no IUP

Intrauterine FHT outside uterus Complex adnexal Echogenic material

fetal pole mass with no IUP in uterus

Fetal heart tones β-hCG above Abnormal or single

discriminatory zone gestational sac

with no IUP

Expect to visualize an IUP

using

(1) Transvaginal ultrasound

and >38 days after LMP or

b-hCG >1500

(2) Abdominal ultrasound and

>45 days after LMP or

b-hCG >4000

b-hCG levels in ectopic

pregnancy are often below

the discriminatory zone!

The first definitive sign of an

IUP is the presence of a yolk

sac within the gestational sac.