(P111) Is That an IUP?

Sunday, September 10, 2023

12:30 PM - 1:00 PM EEST

Poster Presenter / Primary Author(s)

GS

Gagandeep Singh, MD

Ultrasound Fellow
Jacobi Medical Center
New York, New York, United States

Co-Author(s)

AF

Aria Fariborzi, MD

Physician
Montefiore Medical Center/Jacobi Medical Center
Bronx, New York, United States
MH

Michael Halperin, MD, MPH

Emergency Ultrasound Fellowship Director
Jacobi Medical Center
Bronx, New York, United States
Maninder Singh, MD

Director of Healthcare Simulation
Jacobi
Bronx, New York, United States
MM

Michelle Montenegro, MD

Emergency Medicine Attending, Director of Emergency Ultrasound at North Central Bronx Hospital
Jacobi Medical Center/North Central Bronx Hospital
Bronx, New York, United States
NL

Nicole Leonard-Shiu, MD

Director of Resident Emergency Ultrasound Education
Jacobi Medical Center
Bronx, New York, United States
TD

Trevor Dixon, MD

Director of Ultrasound
Jacobi Medical Center
Bronx, New York, United States
TS

Tejpreet Singh, DO

Resident physics.
Jacobi montefiore emergency medicine
Bronx, New York, United States
GM

Glen A. Malaret-Hernandez, MD

Ultrasound Fellow / Attending Physician
Jacobi Medical Center / North Central Bronx Hospital
New York, New York, United States

Chief Complaint : Abdominal cramping and one day of light vaginal spotting

History of Present Illness : A 20-something-year-old female, 6 weeks pregnant by LMP, presented to the ED for abdominal cramping and one day of light vaginal spotting. She used one pad in a 24-hour period without the passage of clots. Denied any history of ovarian cysts, uterine fibroids, or known STDs. Vitals were stable.

Pertinent Physical Exam: The pelvic exam was negative for blood in the vaginal vault and adnexal tenderness. External cervical os was closed on the bimanual exam.

Pertinent Laboratory Data: Positive urine pregnancy.

Case Discussion: A point-of-care ultrasound (POCUS) transabdominal study was done which did not show a clear intrauterine pregnancy (IUP) and was negative for free fluid at the caudal tip of the liver. The right upper quadrant (RUQ) view is the most sensitive when looking for free fluid in the abdomen, and the caudal tip of the liver is the most sensitive location to look for free fluid in the RUQ. [1]

Minimal criteria to rule in an IUP include a gestational sac with a yolk sac, and a myometrial mantle of at least 8 mm.

An endocavitary transvaginal ultrasound was obtained which showed a small amount of free fluid in the Pouch of Douglas. The left adnexa showed a gestational sac with fetal pole and fetal cardiac activity.

The patient was taken to the operating room (OR) based on EM POCUS images.

Teaching Point:

The minimum criteria for diagnosing an IUP are visualizing two organs (uterus and bladder) in order to accurately identify the uterus, a yolk sac within the gestational sac, and the myometrial mantel should be greater than 8 mm at its thinnest segment. The myometrial mantel in this case was less than 5 mm in thickness raising concern for this being an ectopic pregnancy.

References and Acknowledgements (Optional): 1. Lobo V, Hunter-Behrend M, Cullnan E, Higbee R, Phillips C, Williams S, Perera P, Gharahbaghian L. Caudal Edge of the Liver in the Right Upper Quadrant (RUQ) View Is the Most Sensitive Area for Free Fluid on the FAST Exam. West J Emerg Med. 2017 Feb;18(2):270-280. doi: 10.5811/westjem.2016.11.30435. Epub 2017 Jan 19. PMID: 28210364; PMCID: PMC5305137.