Hemoperitoneum assessment in ectopic pregnancy

Objective: To identify routine clinical, ultrasound, and biologic criteria to assess the volume of hemoperitoneum in women with ectopic pregnancy (EP).

Methods: Except for patients with hemodynamic shock, all women assigned to surgical laparoscopic treatment for confirmed EP at Poissy Saint Germain en Laye Hospital between January 2004 and December 2007 were included in the study. The patients underwent abdominal and digital pelvic examination, and standardized ultrasonography. Ordered logistic regression analysis was performed to select criteria associated with an increase in hemoperitoneum. The diagnostic accuracy of each variable was then calculated for different hemoperitoneum cut-off values.

Results: The study included 215 patients. Pelvic pain of 4 or above on a numeric rating scale (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.3-4.1), abdominal guarding or rebound tenderness (OR, 4.6; 95% CI, 2.0-10.8), hemoglobin under 10 g/dL (OR, 12.2; 95% CI, 4.2-35.8), presence of fluid at transvaginal ultrasound (OR, 3.6; 95% CI, 1.4-9.2), and fluid in Morison pouch at abdominal ultrasound (OR, 5.6; 95% CI, 2.0-15.9) were found to be independently associated with hemoperitoneum.

Conclusion: Both clinical examination and standardized ultrasonography were found to be useful for accurate evaluation of hemoperitoneum in patients presenting with EP.