Image 1: Ectopic pregnancy
Image 2: TVUS with bladder shown (upper L) and uterus (center of screen) with no intrauterine pregnancy.
A 30-something year old F with last menstrual period about 2 months prior presents with vaginal spotting and pelvic cramping for a few days. She is hemodynamically stable (BP 111/72, Temp 98.3 F (36.8 C), Heart rate 75, Resp 15, Sp02 99%), and there is a small amount of blood seen on pelvic exam. No free fluid seen in hepatorenal space (image not shown). Point of care transvaginal ultrasound (POC TVUS) shows an empty uterus (image 2) and a gestational sac with an embryo with a fetal heart beat outside of the uterus (image 1). Large bore IV access is obtained, OB/GYN is called and is at bedside evaluating within minutes and takes the patient to the operating room.
POCUS Pearl: Please don’t let a well appearing patient with normal vital signs dissuade you from pursuing the diagnosis of ectopic pregnancy, which remains the leading cause of maternal death in the first trimester.