Using POCUS to Confirm Intrauterine Pregnancy in Urgent Care: A Case Perspective
For clinicians in urgent care, abdominal pain in reproductive-age patients presents a familiar challenge. Add a positive pregnancy test, and the stakes increase significantly, particularly when diagnostic tools are limited onsite.
In a recent case published in the Journal of Urgent Care Medicine (JUCM), Dr. Tatiana Havryliuk demonstrates how transabdominal point-of-care ultrasound (POCUS) can be used effectively to confirm an intrauterine pregnancy (IUP) and help avoid unnecessary emergency department transfers.
👉 Read the full article and view ultrasound images: 28-Year-Old Female with Left Lower Quadrant Pain
Case Presentation:
A 28-year-old female presented to urgent care with mild, non-radiating lower abdominal pain. She had a positive urine pregnancy test and a history of irregular menstrual cycles, making gestational dating uncertain. There was no vaginal bleeding or hemodynamic instability.
Using transabdominal POCUS, the clinician identified an intrauterine gestational sac containing a fetal pole. M-mode imaging confirmed cardiac activity with a heart rate of 168 bpm. Crown-rump length (CRL) measurement dated the pregnancy to 8 weeks. No adnexal masses or free fluid were seen.
With these reassuring findings and no risk factors for heterotopic pregnancy, ectopic pregnancy was ruled out. The patient was safely discharged with outpatient OB-GYN follow-up.
Clinical Lessons:
Use POCUS to confirm IUP. In stable patients, this may allow for in-clinic reassurance and avoid higher-cost downstream care. IUP can be confirmed on transabdominal ultrasound at around 6.5 weeks of gestation.
IUP requires the presence of an intrauterine gestation sac PLUS either a yolk sac or a fetal pole inside the gestation sac. Visualization of the gestation sac alone is not sufficient.
CRL is the most accurate method for first-trimester dating, once a fetal pole is visualized.
Know when to escalate. Patients with risk factors (e.g., IVF) require transvaginal ultrasound and prompt GYN evaluation even if an IUP is seen on POCUS. They are at high risk of heterotopic pregnancy.
Transabdominal imaging is often sufficient to evaluate for IUP, especially once the pregnancy is beyond 6.5 weeks of gestation.
Impact:
For the Patient
Reduces anxiety by providing immediate answers
Avoids unnecessary ED visits, long wait times, and potential exposure to more invasive testing
Ensures timely referral to prenatal care
For the Provider
Enables faster decision-making with objective imaging
Increases confidence in managing early pregnancy complaints
Strengthens the provider-patient relationship by offering timely reassurance and clear next steps
For the Practice
Keeps more care and revenue in-house
Avoids costly and often unnecessary transfers
Demonstrates high-value care through the appropriate use of ultrasound
Positions your clinic as a trusted destination for early pregnancy care
Differentiates your practice in a competitive urgent care landscape
Final Thoughts:
First-trimester pregnancy complaints are common in urgent care, but how we manage them can set us apart. With POCUS, providers can confidently confirm intrauterine pregnancy, reduce unnecessary ED transfers, and provide reassurance in real time.
It’s not just about scanning. It's about elevating care, growing strategically, and making confident decisions at the bedside.
Ready to take the next step with POCUS? Hello Sono helps practices roll out high-quality, compliant, and profitable POCUS programs.