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Emergency Medicine

Answer 3
  1. Surgical consult. The FAST scan is an effective screening tool to detect the presence of free fluid in the abdomen and pelvis.3 Isolated scant amounts of pelvic fluid in a hemodynamically stable pregnant patient has been thought to be physiologic. However, in the pregnant trauma patient, this may not be the case. It is reasonable that if free fluid is noted on a FAST scan, the source of the fluid may indeed be related to intra-abdominal injury rather than physiologic. A surgical consult in this patient would be the most appropriate intervention. Discharging the patient home would not be safe. The patient is only 17 weeks pregnant and fetal monitoring is not indicated, as the fetus is not viable. A DPL would likely not add much, as the FAST scan already noted the presence of fluid. It may be possible to identify the etiology of the fluid, but an infraumbilical approach is not recommended. A transvaginal ultrasound is more sensitive than transabdominal for detecting pelvic free fluid but would add no further information to this case.

    3. Ormsby EL, Geng J, McGahan JP, Richards JR. Pelvic free fluid: clinical importance for reproductive age women with blunt abdominal trauma. Ultrasound Obstet Gynecol 2005;26:271-8.

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