Abdominal pain and hypotensive.
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Large volume echogenic free fluid is present in the pelvis, particularly in the region of the right adnexa, in keeping with haemoperitoneum.
In the right adnexa, a gestational sac is present, up to 2.1 cm in maximal dimension, with a fetal pole evident. No definite fetal heart beat identified on Doppler M-mode assessment. The right ovary was difficult to identify, due to the large amount of adjacent haemoperitoneum. The left ovary was also not well seen. The uterus is anteverted, with a small amount of echogenic fluid/blood in the endometrial cavity. No definite intrauterine gestation was identified.
This patient had a bHCG of 11670. The ultrasound findings are in keeping with a ruptured right adnexal, most likely tubal, ectopic pregnancy, with moderate to large haemoperitoneum.
The findings were discussed with the ED referring doctor and the patient was sent for urgent gynaecological review.