Q: How can the location of a patient’s pregnancy and the fetal heart rate be detected? How can we rule out an ectopic pregnancy?

A: A type of pelvic ultrasound, called a transabdominal ultrasound, is conducted in order to scan the lower abdomen. This less invasive method allows the physician to examine the bladder (appears as a large black circle), the uterus with endometrium thickening, the cervix, fallopian tubes, and ovaries (appear as chocolate chip cookies). This ultrasound can also show bowel movements and usually detects a fetal heart rate. An intrauterine pregnancy (IUP) can be confirmed with a gestation sac located within the uterus and a fetal heart rate, but the patient must be at least 6 weeks pregnant. Physicians are most concerned with the presence of fluid, which can denote an ectopic pregnancy. An ectopic pregnancy is when the fetus develops outside of the uterus, typically in the fallopian tube, and can cause extensive internal bleeding by rupturing the fallopian tube. This condition puts both the mother and the fetus at risk, thus it must be diagnosed and treated rapidly.

Case: A patient at 10 weeks gestation presented in the Yellow Team with slight pelvic pain. A transabdominal ultrasound was conducted to verify an intrauterine pregnancy (IUP). The ultrasound image showed a yolk sac within the uterus which is typical at 10 weeks gestation. However, a fetal heart rate wasn’t detected. There was no fluid present that could point towards an ectopic pregnancy. The ultrasound was also unable to locate the ovaries, so another proper ultrasound was ordered to confirm an IUP.