41
First trimester ultrasound Dr. Kosar Kamal Ahmed H.D diagnostic radiology Lecture 2

First trimester ultrasound

Embed Size (px)

Citation preview

Page 1: First trimester ultrasound

First trimester ultrasound

Dr. Kosar Kamal Ahmed H.D diagnostic radiology

Lecture 2

Page 2: First trimester ultrasound

General considerations -How pregnancy is detected ?

Urine test

Blood test ( beta hCG )

Role of ultrasound

Confirm intra uterine pregnancy

Follow up the growth of pregnancy

Evaluate complications

Diagnose ectopic pregnancy and other pathologies

Page 3: First trimester ultrasound

General considerations Transabdominal and TV US have complementary role ; TV can

show structures in a more detail

First sonographic finding in pregnancy is visualization of the GS

A normal GS is rounded , with a thick echogenic rim around

( double decidual sac sign )

a GS is expecte to be seen when hCG levels reach 1000 – 1200

IU .

Page 4: First trimester ultrasound

General considerations

Page 5: First trimester ultrasound

General considerations

Page 6: First trimester ultrasound

General considerations How to measure GS ?

Calipers should be placed from in to in

Page 7: First trimester ultrasound

General considerations What is the rate of growth of a normal embryo and GS ?

Amniotic sac and embryo increase in size 1 mm / day MSD in mm + 30 = GA in days

CRL in mm + 42 = GA in days

Page 8: First trimester ultrasound

Problems of early pregnancy Miscarriage ( abortion )

Spontaneous abortion Threatened abortion Missed abortion Blighted ovum Complete abortion Incomplete abortion

Traumatic abortion

Page 9: First trimester ultrasound

Problems of early pregnancy Ectopic pregnancy Gestational trophoblastic disease Ovarian problems Uterine fibroids Pregnancy with IUCD

Page 10: First trimester ultrasound

Problems of early pregnancyabortion

Approximately 20 % of women

attending early pregnancy units

suffer a miscarriage

Most women will present with

history of vaginal bleeding and or

abdominal pain

Page 11: First trimester ultrasound

Ultrasound diagnosis of miscarriage

According to ultrasound findings

, miscarriage is classified into :

Threatened

Missed

Incomplete

Complete

(history of V. bleeding + live embryo seen by US )

(absence of cardiac activity in fetal pole )

(V. bleeding , cramps + RPOC)

(V. bleeding , cramps + thin ndometrium “ no RPOC“

Page 12: First trimester ultrasound

Ultrasound diagnosis of miscarriagethreatened abortion

Page 13: First trimester ultrasound

Ultrasound diagnosis of miscarriagemissed abortion

- Absence of cardiac activity in

embryonic poles ( plate )

- Blighted ovum ( Un embryonic

pregnancy )

Absence of embryonic poles in a GS

that measures 8 weeks

Page 14: First trimester ultrasound

Ultrasound diagnosis of abortion complete abortion

Complete abortion

V. bleeding , cramps + empty

uterine cavity with thin

endometrium

Note : pregnancy should be

proven .

Page 15: First trimester ultrasound

Ultrasound diagnosis of abortion incomplete abortion

RPOC Persistent V. bleeding , cramps

decresed + finding of RPOC

Page 16: First trimester ultrasound

Ultrasound diagnosis of abortion incomplete abortion

RPOC

Page 17: First trimester ultrasound

Ultrasound diagnosis of abortion incomplete abortion

RPOC

Page 18: First trimester ultrasound

Ultrasound diagnosis of abortion incomplete abortion

RPOC

Page 19: First trimester ultrasound

Ectopic pregnancy Is implantation of the GS any where outside the

endometrial cavity .

Page 20: First trimester ultrasound

Ectopic pregnancy Is a life threatening condition which if not diagnosed may

lead to internal bleeding and death

Abdominal pain +/- vaginal bleeding

Shock

Page 21: First trimester ultrasound

Ectopic pregnancy

Page 22: First trimester ultrasound

Ectopic pregnancyultrasound findings

Page 23: First trimester ultrasound

Ectopic pregnancyultrasound findings

-About 26 % of ectopic

pregnancies have a normal US

examination

-A potential pitfall is pseudo GS

Page 24: First trimester ultrasound

Ectopic pregnancyultrasound findings

Page 25: First trimester ultrasound

Ectopic pregnancyultrasound findings

Scar pregnancy

Page 26: First trimester ultrasound

Gestational trophoblastic disease molar pregnancy

Page 27: First trimester ultrasound

Gestational trophoblastic disease molar pregnancy

clinical features

Page 28: First trimester ultrasound

Gestational trophoblastic disease molar pregnancy

clinical features

Page 29: First trimester ultrasound

Gestational trophoblastic disease molar pregnancy

Page 30: First trimester ultrasound

Gestational trophoblastic disease molar pregnancy

complete mole

Page 31: First trimester ultrasound

Gestational trophoblastic disease molar pregnancy

complete mole

Page 32: First trimester ultrasound

Gestational trophoblastic disease molar pregnancy

partial mole

Page 33: First trimester ultrasound

Gestational trophoblastic disease molar pregnancy

partial mole

Page 34: First trimester ultrasound

Gestational trophoblastic disease molar pregnancy

invasive mole

Page 35: First trimester ultrasound

Gestational trophoblastic disease molar pregnancy

invasive mole

Page 36: First trimester ultrasound

Gestational trophoblastic disease molar pregnancy

invasive mole

Page 37: First trimester ultrasound

Ovarian problems

Most of the ovarian cysts seen in early pregnancy are corpus luteum

cysts

Normally resolve spontaneousely by the end of first trimester

Complicated ( hemorrhagic ) cysts are of concern and are most

responsible for symptoms “ if not resolve by 16 weeks of gestation

may require surgery as any un resolving complicated cyst harbors risk

of malignancy .

Page 38: First trimester ultrasound

Ovarian problems

Page 39: First trimester ultrasound

Normal position of IUCD

Page 40: First trimester ultrasound

Pregnancy associated with IUCD

Page 41: First trimester ultrasound

Thank you