Is it an Ectopic? No It’s a Knowledge Bomb
Dr. Alexia Armenta
Ectopic pregnancy is the leading cause of death in the 1st trimester of pregnancy. The prevalence in the general population is 1.5-2% of pregnancies, but if you talk to any ED doc or resident, they have seen at least 1 or 2. Mortality is 6-9%, so it’s easy to say, this is a can’t miss diagnosis. By using a linear probe on POCUS in the ED, IUP can be more quickly identified in some patients by the ED physician, without having to send the pt for a formal transvaginal US. This could lead to quicker dispositions and lower cost to the patients. So why not try and identify the IUP yourself?
Tabbut, M., Harper, D., Gramer, D. and Jones, R., 2015. High-frequency Linear Transducer Improved Detection of an Intrauterine Pregnancy in First-trimester Ultrasonography. American Journal of Emergency Medicine, [online] (34), pp.288-291. Available at: <http://dx.doi.org/10.1016/j.ajem.2015.11.001> [Accessed 14 April 2020].
Single center prospective study
88 patients enrolled
Using this technique can reduce ED stay time and cost for a clinically significant amount of patients
I will definitely try and use this technique on my patients who are pregnant in their 1st trimester. I will bring the US with me when I do my initial exam. If I can confidently identify an IUP, I can save the patient the time and discomfort of a transvaginal US, and have them follow up in two days for a repeat beta quant and in a week for a repeat US. If I can’t confidently identify an IUP or they have risk factors for heterotopic pregnancy, then I will just treat as usual.