Case vignette

A 31-year-old woman, gravida 3 para 2, at about 8 weeks pregnant presents with lower abdominal pain. On examination, her vitals are stable and she has adnexal tenderness (left > right). Her urinalysis is normal but her urine pregnancy test is positive. Her β-hCG is 1189. An ultrasound is done with the figures below.

Key questions

1. What is your reading of this ultrasound?

2. How does the quantitative β-hCG affect your interpretation?

3. What are her treatment options?

4. What should her disposition be?

1. Figure 1A is a transabdominal longitudinal view showing free fluid in the posterior cul-de-sac behind the uterus with no evidence of an intrauterine pregnancy (IUP). This is an overall good view since it shows you the related anatomy of the bladder, cervix/vagina, uterus and both cul-de-sacs. Figure 1B is a transvaginal transverse view of the uterus. Once again, we can see free fluid behind the uterus with no evidence of an IUP (no gestational sac, yolk sac or fetal pole). Figure 1C is a transvaginal view of the left adnexa showing the ovary to the left of the screen and …