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Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DCDepartment of Emergency Medicine, MedStar Georgetown University Hospital, Washington, DC
A healthy 36-year-old woman presented with onset of pelvic pain that began about 8 h
prior to arrival in the emergency department (ED). She described the pain as cramping
but intermittently sharp. It was throughout her pelvis and made worse with movement.
The patient had no reported medical or surgical history. On initial evaluation, the
patient's vital signs included a blood pressure of 122/78 mm/Hg and a heart rate of
76 beats/min. Remaining vital signs were unremarkable. The patient appeared uncomfortable
but was not in severe distress. She had tenderness to palpation in both her left and
right lower quadrants without rebound or guarding. Laboratory tests had not yet resulted
at the time of initial evaluation, though initial findings when reported included
a hemogoblin level of 10.5 g/dL and a normal serum chemistry panel. A bedside focused
assessment with sonography in trauma (FAST) examination was performed and showed free
fluid in the right upper quadrant (Figure 1), as well as an intrauterine device (IUD) in place in the uterus (Figure 2).
Figure 1Right upper quadrant (RUQ)/Morison's pouch view obtained by screening bedside ultrasound.
Free fluid (indicated by arrow) noted between liver (ˆ) and right kidney (*).
Figure 2Suprapubic view obtained by screening bedside ultrasound. Complex free fluid (arrow)
noted behind the uterus (*). Intrauterine device is identified as the hyperechoic
line within the uterus (marked on either side by < and >).
Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices.
