What part of history is needed to correctly interpret this ultrasound?
Pregnancy status needs to be confirmed. In this case the bHCG was 11,000.
Large volume echogenic free fluid is present in the pelvis, particularly in the region of the right adnexae, in keeping with haemoperitoneum. There is further moderate volume anechoic free fluid in the pelvis and in the perihepatic space and Morrisons (hepatorenal) pouch.
In the right adnexae, a gestational sac is present, upto 2.1 cm in maximal dimension, with a fetal pole evident. No definite fetal heart beat identified on Doppler M-mode assessment.
The right ovary was difficult to identify, due to the large amount of adjacent haemoperitoneum. The left ovary was also not well seen.
The uterus is anteverted, with a small amount of echogenic fluid/blood in the endometrial cavity. The uterus was difficult to fully characterise as the patient was unable to empty her bladder, but no definite intrauterine gestation was identified.
Conclusion:
Findings are in keeping with a ruptured right adnexal, most likely tubal ectopic pregnancy, associated with moderate to massive haemoperitoneum.