A classic tale: 24yoG2P1 at approximately 6 weeks by LMP presents with vaginal spotting. You perform your pelvic exam, noting scant bleeding and a closed os, followed by a bedside sonogram. But alas, you cannot find an IUP on your transabdominal exam and must move to the invasive intracavitary probe…and guess what, it’s dirty and your tech is on break…

[spacer height=”20px”]Or maybe not.

[spacer height=”20px”]A new study demonstrates that prior to reaching for the intravaginal probe, an uncomfortable process for your patient, you should go for the high frequency linear probe. In this prospective study, of 81 women with first trimester bleeds, 27 women had negative initial transabdominal exams with the curvilinear probe. Of these, 9 women (33%), had a +IUP on transabdominal exam with the linear probe, with an average depth of 3.9cm. Finally, of the remaining 18 women, 3 were found to have a +IUP via transvaginal probe. 
[spacer height=”20px”]While the sample size was on the smaller side, the results were significant, and more importantly, use of the linear probe is harmless and may obviate the need for the less than pleasant transvaginal probe. If, of course, you see nothing on either transabdominal exam, you simply move on to the transvaginal probe.
[spacer height=”20px”]Sources:
Image taken from: sinaiem.us
Tabbut M et al. High-frequency linear transducer improves detection of an intrauterine pregnancy in first trimester ultrasound. Am J Emerg Med 2015 Nov 3; [e-pub]. – See more at:http://www.jwatch.org/na39685/2015/11/19/high-frequency-transabdominal-ultrasound-can-obviate-need#sthash.bRDCrrua.dpuf