Classic findings of tubal ectopic pregnancy (EP)

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  No intrauterine pregnancy (IUP)

  
  
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  Tubal mass

  
  
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  Echogenic fluid in cul-de-sac (peritoneal blood)

Nonspecific adnexal mass is most common finding

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  Tube dilated with blood

  
  
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  Ruptured tube causing adnexal hematoma

Specific findings of tubal EP

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  Adnexal echogenic gestational sac ± yolk sac ± embryo (± heart beat)

  
  
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  Adnexal EP is vascular: “Ring of fire” with color Doppler

Uterus may contain blood or decidual cysts: Can mimic IUP

Peritoneal blood is important sign: Most often in cul-de-sac

90% of all EPs are tubal

Treatment based on ultrasound findings and patient stability: Nonsurgical treatment preferred

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  Medical treatment with 1 or multiple doses of methotrexate if EP < 3-4 cm, patient stable, and no significant hemoperitoneum

  
  
  
  
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    Living embryo is not contraindication

  
  
  
  
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  Surgical treatment

  
  
  
  
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    Salpingostomy (spares tube): Tube incised and EP removed (for nonruptured cases)

    
    
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    Salpingectomy: Tube removed (for ruptured cases)

  
  

Sagittal cul-de-sac view for abnormal fluid is part of every 1st-trimester protocol

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  Look in abdomen if a lot of blood seen in pelvis

Corpus luteum (CL) can mimic tubal EP

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  Use endovaginal probe and hand on patient abdomen to move structures

  
  
  
  
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    EP slides independent of ovary, CL moves with ovary

  
  
  
  
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  CL also has “ring of fire” with color Doppler, showing it is in ovary, not next to ovary