Ultrasound is frequently used to evaluate the patient presenting with pelvic pain and/or vaginal bleeding and may aid in the diagnosis of numerous forms of pathology such as urinary retention, molar pregnancies, and ovarian torsion. Pelvic EUS is most commonly used in the evaluation of pregnant patients who present with signs concerning for ectopic pregnancy or miscarriage. The primary goal of pelvic EUS is to evaluate for the presence of an intrauterine pregnancy (IUP) and assess for risk factors that are concerning for an ectopic pregnancy. Ultrasound of pregnant patients is accomplished with two different scanning techniques: transabdominal and transvaginal.
Pregnant patients presenting with abdominal pain or vaginal bleeding during the 1st trimester must be evaluated for the presence of an ectopic pregnancy. This is commonly accomplished in the ED setting by identifying an IUP in a patient who is at low risk for a heterotopic pregnancy. Patients not receiving infertility treatments with evidence of an IUP can in many circumstances be safely discharged from the ED.
Required Views for the Emergency Department Pelvic Ultrasound
Equipment: Recommended Transducers for Pelvic Sonography
Transabdominal Sonography: Sagittal View
With the indicator pointed toward the patient’s head, place transducer superior to the symphysis pubis (Fig. 24.91).
Identify the bladder, uterus, rectum, ovaries, and the rectouterine pouches (pouch of Douglas). Identify an IUP if present (Fig. 24.92).
Transabdominal Sagittal View. With the indicator pointed toward the patient’s head, place the transducer superior to the symphysis pubis. (Photo contributor: Lawrence B. Stack, MD.)
Transabdominal Sagittal View. Gravid uterus showing cervix and vagina posterior to the bladder. (Ultrasound contributor: Robinson M. Ferre, MD.)
Transabdominal Sonography: Transverse View
From the sagittal view, rotate the transducer 90 degrees counterclockwise so the transducer indicator points to the patient’s right. The transducer should be superior to symphysis pubis (Fig. 24.93).
Identify the bladder, uterus, rectum, ovaries, and the vesicouterine and rectouterine (pouch of Douglas) areas (Fig. 24.94).
Transabdominal Transverse View. From the sagittal view, rotate the transducer 90 degrees counterclockwise so the transducer indicator points to the patient’s right. (Photo contributor: Lawrence B. Stack, MD.)