Skip to main content
SpringerLink
Log in

Emergency Department Ultrasound in Pregnancy

  • Chapter
  • First Online:
Emergency Department Management of Obstetric Complications

  • 1123 Accesses

Abstract

Point-of-care ultrasound is a safe and efficient tool for the assessment of the pregnant patient. Bedside imaging can rapidly diagnose unstable conditions like ectopic pregnancy without the patient ever leaving the emergency department. While obstetricians employ comprehensive ultrasound imaging for a variety of purposes, such as dating or detection of fetal anomalies, the goals of point-of-care ultrasound are limited by design. These studies seek to quickly, but accurately, answer very focused questions and, by necessity, must be narrow in scope. Point-of-care ultrasound can be used for identifying early pregnancy location (intrauterine vs. ectopic vs. indeterminate), gestational dating, and limited fetal biometry. This chapter will describe the technical acquisition of these ultrasound images, both transabdominally and transvaginally, and will discuss image interpretation, including a particular focus on the current controversy surrounding the use of a β-HCG “discriminatory zone.”

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bouyer J, Coste J, Fernandez H, et al. Sites of ectopic pregnancy: a 10-year population-based study of 1800 cases. Hum Reprod. 2002;17(12):3224–30.

    Article  CAS  PubMed  Google Scholar 

  2. American College of Emergency Physicians. Policy statement: definition of clinical ultrasonography. Approved January 2014.

    Google Scholar 

  3. American Institute of Ultrasound in Medicine. AIUM officially recognizes ACEP emergency ultrasound guidelines. Sound Waves Newslett. Issue: November 17, 2011.

    Google Scholar 

  4. American College of Emergency Physicians. Policy statement: emergency ultrasound imaging criteria compendium. Ann Emerg Med. 2006;48:487–510.

    Article  Google Scholar 

  5. Stein JC, Wang R, Adler N, et al. Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: a meta-analysis. Ann Emerg Med. 2010;56:674–83.

    Article  PubMed  Google Scholar 

  6. Doubilet PM, Benson CB. Double sac sign and intradecidual sign in early pregnancy: interobserver reliability and frequency of occurrence. J Ultrasound Med. 2013;32(7):1207–14.

    Article  PubMed  Google Scholar 

  7. Laing FC, Frates MC. Ultrasound evaluation during the first trimester of pregnancy. In: Callen PW, editor. Ultrasonography in obstetrics and gynecology. 4th ed. Philadelphia: WB Saunders Co; 2000.

    Google Scholar 

  8. Bree RL, Edwards M, Böhm-Vélez M, et al. Transvaginal sonography in the evaluation of normal early pregnancy: correlation with HCG level. Am J Roentgenol. 1989;153(1):75–9.

    Article  CAS  Google Scholar 

  9. Noble VE, Nelson BP. First trimester ultrasound. In: Manual of emergency and critical care ultrasound. 2nd ed. Cambridge: Cambridge University Press; 2011.

    Google Scholar 

  10. Mukul LV, Teal SB. Current management of ectopic pregnancy. Obstet Gynecol Clin North Am. 2007;34:403–19.

    Article  PubMed  Google Scholar 

  11. Chin HY, Chen FP, Wang CJ, et al. Heterotopic pregnancy after in-vitro fertilization–embryo transfer. Int J Gynecol Obstet. 2004;86:411–6.

    Article  Google Scholar 

  12. Reece EA, Petrie RH, Sirmans MF, et al. Combined intrauterine and extrauterine gestations: a review. Am J Obstet Gynecol. 1983;146:323–30.

    Article  CAS  PubMed  Google Scholar 

  13. Tal J, Haddad S, Gordon N, et al. Heterotopic pregnancy after ovulation induction and assisted reproductive technologies: a literature review from 1971 to 1993. Fertil Steril. 1996;66:1–12.

    Article  CAS  PubMed  Google Scholar 

  14. Inion I, Gerris J, Joostens M, et al. An unexpected triplet heterotopic pregnancy after replacement of two embryos. Hum Reprod. 1998;13:1999–2001.

    Article  CAS  PubMed  Google Scholar 

  15. Filly RA. Ectopic pregnancy: the role of sonography. Radiology. 1987;162:661.

    Article  CAS  PubMed  Google Scholar 

  16. Bhatt S, Ghazale H, Dogra VS. Sonographic evaluation of ectopic pregnancy. Radiol Clin North Am. 2007;45:549.

    Article  PubMed  Google Scholar 

  17. Nyberg DA, Hughes MP, Mack LA, et al. Extrauterine findings of ectopic pregnancy of transvaginal US: importance of echogenic fluid. Radiology. 1991;178(3):823–6.

    Article  CAS  PubMed  Google Scholar 

  18. Sickler GK, Chen PC, Dubinsky TJ, et al. Free echogenic pelvic fluid: correlation with hemoperitoneum. J Ultrasound Med. 1998;17(7):431–5.

    Article  CAS  PubMed  Google Scholar 

  19. Doubilet PM, Benson CB, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 2013;369:1443–51.

    Article  CAS  PubMed  Google Scholar 

  20. Barnhart K, Mennuti MT, Benjamin I, et al. Prompt diagnosis of ectopic pregnancy in an emergency department setting. Obstet Gynecol. 1994;84(6):1010–5.

    CAS  PubMed  Google Scholar 

  21. Kaplan BC, Dart RG, Moskos M, et al. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med. 1996;28(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  22. Wang R, Reynolds TA, West HH, et al. Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography. Ann Emerg Med. 2011;58(1):12–20.

    Article  PubMed  Google Scholar 

  23. Ko JK, Cheung VY. Time to revisit the human chorionic gonadotropin discriminatory level in the management of pregnancy of unknown location. J Ultrasound Med. 2014;33:465–71.

    Article  PubMed  Google Scholar 

  24. Doubilet PM, Benson CB. Further evidence against the reliability of the human chorionic gonadotropin discriminatory level. J Ultrasound Med. 2011;30:1637–42.

    Article  PubMed  Google Scholar 

  25. Hahn SA, Lavonas EJ, Mace SE, et al. Clinical policy: Critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. Ann Emerg Med. 2012;60(3):381–90.

    Article  PubMed  Google Scholar 

  26. Daya S. Accuracy of gestational age estimation by means of fetal crown-rump length measurement. Am J Obstet Gynecol. 1993;168(3):903–8.

    Article  CAS  PubMed  Google Scholar 

  27. Wisser J, Dirschedl P, Krone S. Estimation of gestational age by transvaginal sonographic measurement of greatest embryonic length in dated human embryos. Ultrasound Obstet Gynecol. 1994;4(6):457–62.

    Article  CAS  PubMed  Google Scholar 

  28. Robinson HP, Fleming JE. A critical evaluation of sonar “crown-rump length” measurements. Br J Obstet Gynaecol. 1975;82(9):702–10.

    Article  CAS  PubMed  Google Scholar 

  29. Butt K, Lim K. Society of Obstetricians and Gynaecologists of Canada. Determination of gestational age by ultrasound. J Obstet Gynaecol Can. 2014;36(2):171–83.

    Article  PubMed  Google Scholar 

  30. National Institute for Health and Clinical Excellence. Antenatal Care (CG62). Published March 2008, last updated March 2016. http://guidance.nice.org.uk/CG62.

  31. Salomon LJ, Alfirevic Z, Bilardo CM, et al. ISUOG practice guidelines: performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2013;41(1):102–13.

    Article  CAS  PubMed  Google Scholar 

  32. American College of Obstetricians and Gynecologists. Committee opinion no 611: method for estimating due date. Obstet Gynecol. 2014;124(4):863–6.

    Article  Google Scholar 

  33. Campbell S, Warsof SL, Little D, et al. Routine ultrasound screening for the prediction of gestational age. Obstet Gynecol. 1985;65(5):613–20.

    CAS  PubMed  Google Scholar 

  34. Benson CB, Doubilet PM. Sonographic prediction of gestational age: accuracy of second- and third-trimester fetal measurements. Am J Roentgenol. 1991;157(6):1275–7.

    Article  CAS  Google Scholar 

  35. Filly RA, Hadlock FP. Sonographic determination of menstrual age. In: Callen PW, editor. Ultrasonography in obstetrics and gynecology. 4th ed. Philadelphia: WB Saunders Co; 2000.

    Google Scholar 

  36. Hadlock FP. Sonographic estimation of fetal age and weight. Radiol Clin North Am. 1990;28(1):39–50.

    CAS  PubMed  Google Scholar 

  37. Doubilet PM, Benson CB. Embryonic heart rate in the early first trimester: what rate is normal? J Ultrasound Med. 1995;14(6):431–4.

    Article  CAS  PubMed  Google Scholar 

  38. Lulić Jurjević R, Podnar T, Vesel S. Diagnosis, clinical features, management, and post-natal follow-up of fetal tachycardias. Cardiol Young. 2009;19(5):486–93.

    Article  PubMed  Google Scholar 

  39. American Institute of Ultrasound in Medicine. Official statement: statement on measurement of fetal heart rate. Approved November 5, 2011.

    Google Scholar 

  40. American Institute of Ultrasound in Medicine. Official statement: statement on the safe use of doppler ultrasound during 11–14 week scans (or earlier in pregnancy). Approved March 21, 2016.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, 20007, USA

    Cory Wittrock M.D.

  2. Division of Emergency Medicine, Department of Surgery, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA

    Erica Peethumnongsin M.D.

Authors
  1. Cory Wittrock M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erica Peethumnongsin M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cory Wittrock M.D. .

Editor information

Editors and Affiliations

  1. MedStar Georgetown University Hospital and MedStar Washington Hospital Center, Georgetown University School of Medicine, Washington, DC, USA

    Joelle Borhart

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Wittrock, C., Peethumnongsin, E. (2017). Emergency Department Ultrasound in Pregnancy. In: Borhart, J. (eds) Emergency Department Management of Obstetric Complications. Springer, Cham. https://doi.org/10.1007/978-3-319-54410-6_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-54410-6_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54409-0

  • Online ISBN: 978-3-319-54410-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation