In cases of traumatic injury in females with confirmed or estimated pregnancy greater than 20 weeks gestation, OBGYN expert consultation should be sought as soon as possible, and a transabdominal ultrasound must be performed to evaluate fetal well-being as soon as the mother is stabilized.
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During the FAST (Focused Assessment with Sonography in Trauma) exam, a transabdominal ultrasound is performed to assess for free fluid in the abdomen and to investigate the potential presence of intrauterine pregnancy (IUP). If IUP is identified, further assessment should include fetal heart rate, the amount of amniotic fluid, fetal movement, and the placenta. In the setting where a female of reproductive age presents with minor or major trauma, pregnancy is automatically assumed until it is ruled out with serum or urine pregnancy tests. However, in the presence of concerning symptoms such as vaginal bleeding, abdominal or pelvic pain in a female with a positive pregnancy test, an emergent pelvic ultrasound must be performed to rule out an ectopic pregnancy. If there are no concerning symptoms in pregnancy, a routine ultrasound should be performed at 10 to 13 weeks gestational age to establish accurate gestational age, determine viability, and determine the number of fetuses. It appears as a uniformly echogenic structure with rounded margins, usually located along the anterior or posterior uterine wall, where it is seen as a thickened echogenic rim of tissue surrounding the gestational sac. The placenta is visible by 10 weeks gestational age with a transabdominal ultrasound. The fetal heartbeat becomes detectable at 6 weeks of gestational age and is described initially as a “flickering” structure. The ovaries and Fallopian tubes are paired female reproductive organs that can be found lateral to the uterus.
The uterus contains the gestational sac during pregnancy which is typically visualized in the center of the uterine body at 4.5 to 5 weeks of gestation and is the first structure visualized in pregnancy. The three parts of the uterus can be visualized with the use of transvaginal ultrasound, beginning most caudal: cervix, body, and then the fundus. The uterus is located posterior to the bladder and anterior to the colon. Ultrasound can be used transvaginally or transabdominally to view the female reproductive anatomy, with a transvaginal approach allowing for better visualization of structures.
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