Introduction

Ectopic pregnancy (EP) is the leading cause of maternal mortality in the United States and is estimated to have a prevalence of 8% in pregnant patients presenting to the ED for any complaint (1, 2). Indeed, the incidence of ectopic pregnancy has been rising since the mid-1980s (3). Therefore, any female of child-bearing age who comes to the emergency room with abdominal pain, vaginal bleeding, near-syncope, or syncope has ectopic pregnancy on the differential. This is a “can't miss” diagnosis. Given the volume of female patients presenting with these complaints, an algorithm incorporating first trimester ultrasound can be timesaving for the physician and patient but must increase efficiency without compromising safety.

The evaluation for ectopic pregnancy differs from other indications for bedside ultrasound. Evaluation of the uterus seeks to confirm an intrauterine pregnancy (IUP), ruling out ectopic gestation by exclusion. Visualization of the actual ectopic pregnancy is not the goal. In contrast, evaluation of the aorta, heart, and other organs typically confirms pathology (aneurysm, asystole, hydronephrosis) via direct visualization.

There are instances where an extrauterine gestation will be seen on bedside ultrasound or free fluid will be seen in a hypotensive pregnant female and ectopic pregnancy will be diagnosed or inferred. This will be the exception, however, to how bedside ultrasound is used for this application. Bedside ultrasonography instead will be used to increase the number of IUP cases that can be definitively diagnosed and discharged in the ED without further imaging.