Abstract
Background. Bedside sonography performed by emergency physicians is frequently utilized for real-time clinical decision-making in the emergency department (ED) setting. This includes the sonographic evaluation of pain or bleeding in the first trimester of pregnancy. The detection of intrauterine pregnancy (IUP) or life-threatening conditions, including ectopic pregnancy, is critical. Objectives. This paper will review several important pearls and avoidable pitfalls of this diagnostic modality by brief presentation of illustrative cases followed by discussion of key principles. Case Reports. Three patients evaluated in the ED for bleeding or pain occurring during the first trimester of pregnancy will be presented. Conclusions. When conducting emergency bedside ultrasound for the evaluation of first trimester pregnancy, it is important to avoid common pitfalls that can place your patient at risk.
Highlights
Studies have demonstrated that emergency physicians (EPs) can competently perform focused bedside sonography for the evaluation of first trimester pregnancy in the emergency department (ED) [1, 2]
The discriminatory zone is defined as the level of βHCG above which an intrauterine pregnancy (IUP) can be reliably detected by ultrasound [6]
It is important for the EP to consider the diagnosis of ectopic pregnancy with pain or bleeding and consider diagnostic ultrasound even if the βhCG level falls below the discriminatory zone threshold value
Summary
Bedside sonography performed by emergency physicians is frequently utilized for real-time clinical decision-making in the emergency department (ED) setting. This includes the sonographic evaluation of pain or bleeding in the first trimester of pregnancy. This paper will review several important pearls and avoidable pitfalls of this diagnostic modality by brief presentation of illustrative cases followed by discussion of key principles. Three patients evaluated in the ED for bleeding or pain occurring during the first trimester of pregnancy will be presented. When conducting emergency bedside ultrasound for the evaluation of first trimester pregnancy, it is important to avoid common pitfalls that can place your patient at risk
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