In this image, not only is there no clear live IUP but there is also free fluid noted in the pelvis (arrows). This is an ectopic until proven otherwise! Fortunately for this patient, a formal TV US was performed and an IUP was confirmed.
The intrauterine anechoic sac seen here is a can be a pseudo--gestational sac and is easily mistaken for an early viable pregnancy, but this is actually present in many ectopic pregnancies. Until we are credentialed to make decisions on our own TV or TA ultrasounds, we must confirm findings such as these with formal radiology studies.
Our definitive ED POC question here is "is there a definitive IUP?" That means ? an intrauterine gestational sac containing a yolk sac and a fetal pole (approx the 5th week) or the identification of an intrauterine heart beat (approx the 6th week). With fetal heart rate evaluation, make sure it's the correct rate for a fetus using M-mode.
And finally, when doing your next TA pelvis ultrasound, a full bladder and excellent fanning through both the transverse and sagittal planes will help maximize your images. Zooming in to the gestation sac, fanning SLOWLY will help in identification of the fetal heart. If not, empty the bladder, and use the TV US transducer.
Again, we are always happy to clarify further and please feel free to email us with any thoughts or questions or interesting ultrasound cases!