Solution: Ectopic pregnancy is a common problem in which the pregnancy begins development in a position outside the uterus. 90+% of the time these occur in the fallopian tubes, but they can also occur in the peritoneum, in the ovary, and in the cervix. The presentation is variable, but often includes pain, bleeding, and if there has been rupture, signs of blood loss. US evaluation requires a thorough evaluation of the endometrium to look for an intra-uterine pregnancy (heterotopic pregnancies are rare, especially if there is not history of fertility drugs), evaluation of the abdomen for free fluid (which can represent hemorrhage as seen in this case), and evaluation of the adnexa to see if the ectopic pregnancy can be identified (this may not be possible). The identification of significant free fluid as seen in this case can indicate hemorrhage and may be an indication for surgery. Otherwise, these can often be treated medically with methotrexate.