Top 3 Articles: Pelvic US

Miscarriage in progress from Sinai EM Ultrasound on Vimeo.

Pelvic ultrasound is one of our core US applications. It has been incorporated within many emergency departments and it is a bread and butter skill for the EP. So, how do we fare in our performance?

This early study showed that ED ultrasound was very similar to radiology department findings (or final outcome, or both) in 96% of the study cohort. Also, when ED ultrasound accurately identified IUPs, ectopic pregnancies were effectively ruled out with a NPV of 100%.

1. Durham, B., Lane, B., Burbridge, L., & Balasubramaniam, S. (1997). Pelvic ultrasound performed by emergency physicians for the detection of ectopic pregnancy in complicated first-trimester pregnancies. Annals of Emergency Medicine, 29(3), 338-47.

Also, why do we do it in the first place, and not send all the cases to radiology for ultrasound? The answer lies in the reduction of both ED length of stay as well as cost. Any means to reduce ED overcrowding and decrease spending are welcome!

2. Shih, C. H. (1997). Effect of emergency physician-performed pelvic sonography on length of stay in the emergency department. Annals of Emergency Medicine, 29(3), 348-51; discussion 352.

Lastly, when ectopic pregnancy is suspected, remember to perform a FAST exam as a positive finding (free fluid in Morison’s pouch) can predict the need for operative intervention.

3. Moore C, Todd WM, O’Brien E, Lin H. Free fluid in Morison’s pouch on bedside ultrasound predicts need for operative intervention in suspected ectopic pregnancy. Acad Emerg Med. 2007;14:755-758.