Is an intrauterine pregnancy (IUP) (defined as yolk sac or fetal pole) present?

 Abdominal or pelvic pain

 Suspected ectopic pregnancy or risk factors for ectopic pregnancy

 Vaginal bleeding

 Unexplained syncope, or hypotension

 Pelvic mass

CONTRAINDICATIONS

 Absolute: None

 Relative (transvaginal approach): Recent major pelvic surgery

CONSENT

 Get verbal or written consent for the procedure, except in extremis situations

RISKS

 No documented harmful effects on the fetus or the mother due to ultrasound exposure

LANDMARKS

 Transabdominal

    Have the patient lie supine

    The bladder should be full in order to have an adequate acoustic window

    Use a standard curved 3.5- to 5.0-MHz probe to scan the lower abdomen

    Place the probe on the anterior abdominal wall, at the level of the symphysis pubis

    For advanced gestations, place the probe more proximally

 Transvaginal

    Insert the probe into the vaginal canal

    The uterus is midline, posterior to the bladder and anterior to the rectum (FIGURE 44.1)

    The right and left ovaries are lateral to the uterus and anteromedial to the right and left iliac vessels

    Anteroflexed uterus 90% and retroflexed in 10%

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