Case Review: Ultrasound of Ruptured Ectopic Pregnancy - a podcast by Daniel J. Kowal, MD

In this radiology lecture, we discuss the ultrasound appearance of ruptured ectopic pregnancy.

Key points include:



* Most ectopic pregnancies occur in the fallopian tube: Ampulla most common, followed by isthmus and fimbria.

* Risk factors: Prior ectopic pregnancy, prior surgery (fallopian tube), pelvic inflammatory disease, endometriosis, IVF.

* “A single measurement of hCG, regardless of its level, does not reliably distinguish between ectopic and intrauterine pregnancy (viable or nonviable).”*

* Levels of hCG in ectopic pregnancies are highly variable.

* Tubal rupture main complication, occurs in up to 20%.

* Free fluid in pelvis alone nonspecific, but echogenic fluid in Morison pouch (subhepatic space) and cul-de-sac raises concern for rupture.

* Rupture is a relative contraindication to methotrexate (medical) therapy.



*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.

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