Isolated fluid in the cul-de-sac: How well does it predict ectopic pregnancy?

Hemoperitoneum assessment in ectopic pregnancy

“…Although it is usually thought that evidence for abundant hemoperitoneum will be clearly observed at ultrasound examination [8,20], the present work has attempted to relate preoperative signs to specific amounts of hemoperitoneum found at laparoscopy.…”

“…Another sonogram picture available at TVUS examination was the view of the uterus in a mid-sagittal plane, an image that was adapted from a study by Dart et al [20]. In both this and the previous study [13], this view allowed a semi-quantitative estimate of the hemoperitoneum volume measured during surgery, especially to discriminate a minor from a significant hemoperitoneum.…”

“…A detailed description of the standardized sonograms has been reported elsewhere [19]. Ultrasound variables of hemoperitoneum were considered to be positive when the pelvic intra-peritoneal effusion exceeded the uterine fundus or was found around the ovary [13,20], or abdominal effusion was visible in Morison pouch [10,11]. All patients had ultrasonography while in the emergency unit.…”

Differential Diagnosis of Ectopic Pregnancy - Morbidity and Mortality

“…If it cannot be moved independently of the ovary, it is unlikely to be an ectopic pregnancy [17]. A moderate amount of anechoic free fluid (tracking more than one third of the way up the posterior wall of the uterus), or any echogenic free fluid, has a higher chance of being ultimately diagnosed as an ectopic pregnancy [18]. Culdocentesis is the transvaginal needle aspiration of fluid from the posterior cul-de-sac of Douglas.…”

Sonography in first trimester bleeding

“…29 Echogenic fluid in the cul-de-sac is an important feature of ectopic pregnancy [30][31][32] ( Figure 11). Nyberg et al 30 demonstrated that echogenic fluid is the only abnormal finding in 15% of ectopic pregnancies.…”