Pediatric emergency medicine trisk 4502 4502
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FIGURE 131.16 Standard transvaginal view of uterus.
In normal pregnancy, the earliest sonographic finding of an IUP is the
gestational sac, which appears as a round fluid collection within the uterus (
Video 131.15 ). In transabdominal scanning, the gestational sac can be seen as
early as 5 to 6 weeks’ gestational age. Transvaginal scanning can reliably detect
this finding about 7 to 10 days earlier. The yolk sac can be seen inside the
gestational sac at approximately 6 to 7 weeks’ gestational age (5 to 6 weeks by
transvaginal scanning) and most authors consider this as definitive evidence of
IUP. A normal embryo will appear at the margin of the yolk sac at about 6.5 to
7.5 weeks’ gestational age and cardiac activity can be detected shortly thereafter (
Video 131.16 ).
In the pregnant female, the standard for confirming an IUP on an emergency
physician performed bedside ultrasound requires visualization of an intrauterine
yolk sac, fetal pole, or intrauterine fetal heartbeat. Visualizing only the gestational
sac is not adequate as this can be the result of hormonal stimulation from an
ectopic pregnancy. When a fetal heartbeat can be seen, it should be documented
with M-mode.
In an ectopic pregnancy, an adnexal mass or free fluid in the pelvis can
sometimes be seen. However, visualization of the ectopic pregnancy should not
be the goal of the emergency physician. Several protocols have been developed
