Use of point-of-care ultrasound to diagnose spontaneous rupture of fibroid in pregnancy

Abstract

Background: Complications of fibroids in pregnancy are well known, including postpartum hemorrhage, labor dystocia, and cesarean delivery. Outside of pregnancy and labor, the rare occurrence of spontaneous fibroid rupture has been documented. Case: The current case report involves a woman who presented with acute abdominal pain in the third trimester of pregnancy and was found to have spontaneous rupture of a fibroid before the onset of labor. Her initial presentation, diagnosis through use of point-of-care ultrasound, acute surgical management, and postoperative course are described. Conclusion: When assessing acute abdominal pain in a pregnant patient, fibroid rupture should be considered despite the absence of prior uterine surgery. Bedside point-of-care ultrasonography is a useful tool for assessment of abdominal pain in the third trimester of pregnancy.

Intra-Abdominal Hemorrhagic Catastrophe due to Large Subserous Myomatous Capsular Venous Rupture

“…Establishing a diagnosis in cases of large pelvic tumors with hemoperitoneum is difficult [ 14 ]. In both pregnant and nonpregnant patients presenting with abdominal pain and concern for active hemorrhage, point-of-care ultrasound (POCUS) has been utilized for triage and management decision-making [ 15 ]. The ultrasound aided in diagnosis of intra-abdominal hemorrhage and the large size of fibroid in our case.…”

A Call for Development of Point‐of‐Care Ultrasound Training Recommendations in Obstetrics and Gynecology Residency

“…Procedurally, POCUS training could include intravenous line placement in cases where urgent access is needed 23 . Diagnostically, abdominal pain in pregnancy has a broad differential that can be quickly narrowed by POCUS to allow for rapid diagnosis and triage of the patient, whether the etiology is ruptured ectopic pregnancy, pelvic abscesses, or hemorrhage 24,25 . Urgent identification of pulmonary edema in patients with preeclampsia, peripartum dyspnea, deep vein thrombosis, or pulmonary vascular emergency can be incredibly challenging; POCUS improves diagnostic accuracy for each of these conditions 26,27 …”

“…While there is no formal ACGME requirement at this time for POCUS training in Ob/Gyn, there is evidence that POCUS aids in that pursuit of excellence, and calls are mounting for these skills to be formalized in training requirements. 24,37,38 Ob/Gyn residencies that begin to implement a formal POCUS curriculum will be on the cutting edge of this educational development. As nearly all other areas of inpatient medicine regularly utilize bedside POCUS skills to manage urgent clinical conditions that obstetricians and gynecologists also encounter, it is time for their training to reflect the necessity of learning these skillsets.…”

“…The goal of every Ob/Gyn residency is to use the best of educational innovation and equip graduates for excellent patient care. While there is no formal ACGME requirement at this time for POCUS training in Ob/Gyn, there is evidence that POCUS aids in that pursuit of excellence, and calls are mounting for these skills to be formalized in training requirements 24,37,38 . Ob/Gyn residencies that begin to implement a formal POCUS curriculum will be on the cutting edge of this educational development.…”

“…23 Diagnostically, abdominal pain in pregnancy has a broad differential that can be quickly narrowed by POCUS to allow for rapid diagnosis and triage of the patient, whether the etiology is ruptured ectopic pregnancy, pelvic abscesses, or hemorrhage. 24,25 Urgent identification of pulmonary edema in patients with preeclampsia, peripartum dyspnea, deep vein thrombosis, or pulmonary vascular emergency can be incredibly challenging; POCUS improves diagnostic accuracy for each of these conditions. 26,27 Training in the use of POCUS during Ob/Gyn residency is critical, but has not received the attention directed to other specialties.…”