By Will Kropf, Member of SAEM-AEUS
Using point of care ultrasound (POCUS) to assess for ectopic pregnancy is associated with shorter ED length of stay for all ectopic pregnancies and faster time to the OR for ruptured ectopics, when compared to radiology-based US alone.
Why does this matter?
Intra-abdominal hemorrhage associated with ectopic pregnancy is a leading cause of maternal mortality. POCUS can find intrauterine pregnancy (IUP), but if absent, and free fluid is present, ectopic is likely. Authors propose the RUPTURE exam: Right Upper and Pelvic Timely Ultrasound for Ruptured Ectopic to expedite care for life-threatening hemorrhage.
Get ruptured ectopics to the OR faster with POCUS
This was a retrospective, observational, cohort review of 109 patients admitted for operative management of newly diagnosed ectopic pregnancy. 36 received transabdominal POCUS (of whom 26 also received radiology-based ultrasound) and 73 had a transvaginal radiology ultrasound study (RADUS) only. Mean ED dwell times for POCUS and RADUS patients were 158 and 206 minutes, respectively.
31/36 patients in the POCUS group and 47/73 in the RADUS group were found to have ruptured ectopic in the OR. Median times to OR in these patients for the POCUS and RADUS groups were 203 and 293 minutes, respectively. Authors attempted to control the primary outcome for variables such as positive shock index, race, and visits during “off hours,” but sample size was too small.
Patients with only POCUS all had free fluid in the RUQ and >1200mL blood in the OR. While patients in this subgroup were likely sicker, this is the population that requires rapid differentiation, and therefore where POCUS shines.
Bottom Line: POCUS reduces time to disposition for ectopic pregnancy and time to OR for ruptured ectopics.
Impact of point-of-care ultrasound on treatment time for ectopic pregnancy. Am J Emerg Med. 2021 Jun 9;49:226-232. doi: 10.1016/j.ajem.2021.05.071. Epub ahead of print.