This young healthy woman presented in her first trimester of pregnancy with lower abdominal pain and vaginal bleeding. She had diffuse abdominal tenderness and was mildly tachycardic with a normal blood pressure. After IV access was established, labs and blood bank sample were sent, and the following ultrasound of the right upper quadrant was obtained:
So there’s a bit of free fluid in Morison’s pouch. Can we make it more evident for the kids in the back row? The next image was taken with the patient in Trendelenberg position:
That made a pretty big difference.
In this sagittal view of the uterus the bladder is visible to the screen right; there is free fluid in the pelvis just to the left of this, and it can be seen to move with probe pressure on the lower abdomen.
Thus a diagnosis of ruptured ectopic pregnancy was strongly suspected, and the patient underwent emergency laparoscopy with the obstetrics service.