A small amount of anechoic free fluid in the posterior cul de sac is normal in both intra- and extrauterine pregnancies [91]. Larger amounts of complex free fluid, particularly in Morrison’s pouch by the liver, may indicate rupture of an EP, and correlates well to hemoperitoneum observed intraoperatively [91, 92]. Hemoperitoneum can be assessed in the emergency setting using a Focused Assessment with Sonography for Trauma (FAST) scan, which is a bedside ultrasound assessing for free fluid in the perihepatic, perisplenic and pelvic space; the full trauma assessment, not applicable to patients with suspected EP, also includes the pericardial space [93]. The determination of extent of hemoperitoneum and need for intervention depends on clinician assessment and the patient's hemodynamic stability. Of note, if an ultrasound shows an IUP, the risk of EP is much reduced, though not zero. Though rare, the patient may still be at risk of heterotopic pregnancy, particularly following IVF [94].
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