POCUS: 1st Trimester Pregnancy Case 6 - Pregnancy Unknown Location

Pregnancy of unknown location can be a diagnostic dilemma since this could represent a normal early pregnancy, miscarriage or an ectopic pregnancy or even other pathologies. Mindful workup of these patients is necessary to not miss a life threatening ectopic pregnancy either on initial visit or when subsequent visits are needed.
Ultrasound is a key component in the work up of patients in early pregnancy but may still not identify location.
In this video we review the trans abdominal (1:20) and transvaginal (6:00) pelvic anatomy of a patient presenting with vaginal bleeding in early pregnancy. The location of the pregnancy could not be identified in this case and is often the case in patients presenting with pregnancy related complaints in the 1st trimester.
In addition to the reviewed anatomy, findings of free fluid in the pelvis is identified, fluid filled loops of bowel, and absence of adnexal masses.
The utilization of beta-HCG (9:30) is discussed as a data point in the work up and it’s relation to ultrasound findings.
Signs of ectopic pregnancy are discussed and ultrasound should include assessment for these findings. Any presence of these findings suggest or define and ectopic pregnancy (15:01).
Reading Resources:
www.emdocs.net/ectopic-pregnancy/
www.acep.org/patient-care/cli...
canadiem.org/β-hcg-discrimina...
radiopaedia.org/articles/ecto...
unmfamilyplanning.pbworks.com/...
www.nejm.org/doi/pdf/10.1056/...
www.tandfonline.com/doi/pdf/1...
pubmed.ncbi.nlm.nih.gov/18450...