Ultrasound can also be used to help recognize hemoperitoneum resulting from ectopic preg­nancy. This may be done as a part of a routine pelvic ultrasound or as part of a Focused Assessment with Sonography in Trauma also known as a FAST scan. In one study of patients with a conrmed ectopic pregnancy at the time of

The key to safe and prompt surgical management of ectopic pregnancy is proper visualization, which can be difcult in the setting of tubal rup­ture and hemoperitoneum. Immediately upon laparoscopic entry blood may be encountered, completely obscuring the pelvic organs. It is important to slowly place the laparoscope into the abdomen to avoid contact with blood, as this will quickly dirty the lenses and repeated pauses to clean the camera may cause signicant delay in treatment. Once the laparoscope is success­fully within the abdomen, a few techniques can be used to quickly improve visualization. Extensive suctioning of blood can be time­consuming, especially with large clots, and fur­ther slow identication of the bleeding source. A sponge stick can be placed into the vagina or a uterine manipulator can be inserted (if an intra­uterine pregnancy has been ruled out) to elevate the uterus and fallopian tubes above the blood and allow rapid identication of the source of bleeding. The patient can also be placed into steep Trendelenburg to quickly facilitate move­ment of bowel and blood out of the pelvis. In cases of extremely brisk bleeding, the area can be immediately grasped with a nontraumatic instru­ment to stop further bleeding while additional port access, a coagulation device, etc. is obtained. Once appropriate visualization is secured, hemo-