Background: Early pregnancy complaints in emergency medicine are common. Emergency physicians increasingly employ ultrasound in the evaluation of these complaints. As a result, it is likely that rare, though important, diagnoses will be encountered. We report a case of fetal anencephaly diagnosed by bedside emergency ultrasound in a patient presenting with first trimester vaginal bleeding.

Case Report: A 33 year-old patient at 10 weeks gestation presented with vaginal bleeding. After initial history and physical examination, a bedside ultrasound was performed. The emergency physician noted the abnormal appearance of the fetal cranium and anencephaly was suspected. This finding was confirmed by a consultative high-resolution fetal ultrasound. Making the diagnosis at the point of care allowed earlier detection, and more comprehensive maternal counseling about pregnancy options. This particular patient underwent elective abortion which was able to be performed at an earlier gestation, decreasing maternal risk.  If this diagnosis would not have been recognized by the emergency physician at the point of care, it may not have been diagnosed until the second trimester, and lower risk maternal options would not have been available.