A mid 20s yo F presented with acute onset lower abdominal pain for 12 hours; constant with missed LMP and slight vaginal discharge. Patient shows a positive home pregnancy test from her purse which she took last night. The patient is in significant pain and clutching her lower abdomen. On exam, she has a nonrigid abdomen with significant lower abdominal tenderness and guarding. Labs including a urine pregnancy test had yet to been obtained.
Vital signs: BP 106/74 HR 102 Temp 97.4 F RR 20 Sp02 98%
POCUS Hepatorenal Space: Positive anechoic fluid in Morrison’s pouch to the caudal tip of the liver’s edge.
Chris’ POCUS PEARL: Any female of child bearing age that presents with abdominal pain can quickly be assessed at the bedside with ultrasound for peritoneal free fluid. Even before a pregnancy test result returns! This patient had significant abdominal pain, slightly low blood pressure and tachycardia which also further supports high suspicion of a ruptured ectopic. OBGYN was consulted immediately and the patient was taken to the OR where she was found to have a right tubal pregnancy. She was discharged home in good condition the same day.
Christopher Griffiths, PA-C.
Of Note: Eight hundred women still die from pregnancy related complications every day. [World Health Organization. "Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division." (2020).]