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First trimester ultrasound
Dr. Kosar Kamal Ahmed H.D diagnostic radiology
Lecture 2
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
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 .
General considerations
General considerations
General considerations How to measure GS ?
Calipers should be placed from in to in
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
Problems of early pregnancy Miscarriage ( abortion )
Spontaneous abortion Threatened abortion Missed abortion Blighted ovum Complete abortion Incomplete abortion
Traumatic abortion
Problems of early pregnancy Ectopic pregnancy Gestational trophoblastic disease Ovarian problems Uterine fibroids Pregnancy with IUCD
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
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“
Ultrasound diagnosis of miscarriagethreatened abortion
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
Ultrasound diagnosis of abortion complete abortion
Complete abortion
V. bleeding , cramps + empty
uterine cavity with thin
endometrium
Note : pregnancy should be
proven .
Ultrasound diagnosis of abortion incomplete abortion
RPOC Persistent V. bleeding , cramps
decresed + finding of RPOC
Ultrasound diagnosis of abortion incomplete abortion
RPOC
Ultrasound diagnosis of abortion incomplete abortion
RPOC
Ultrasound diagnosis of abortion incomplete abortion
RPOC
Ectopic pregnancy Is implantation of the GS any where outside the
endometrial cavity .
Ectopic pregnancy Is a life threatening condition which if not diagnosed may
lead to internal bleeding and death
Abdominal pain +/- vaginal bleeding
Shock
Ectopic pregnancy
Ectopic pregnancyultrasound findings
Ectopic pregnancyultrasound findings
-About 26 % of ectopic
pregnancies have a normal US
examination
-A potential pitfall is pseudo GS
Ectopic pregnancyultrasound findings
Ectopic pregnancyultrasound findings
Scar pregnancy
Gestational trophoblastic disease molar pregnancy
Gestational trophoblastic disease molar pregnancy
clinical features
Gestational trophoblastic disease molar pregnancy
clinical features
Gestational trophoblastic disease molar pregnancy
Gestational trophoblastic disease molar pregnancy
complete mole
Gestational trophoblastic disease molar pregnancy
complete mole
Gestational trophoblastic disease molar pregnancy
partial mole
Gestational trophoblastic disease molar pregnancy
partial mole
Gestational trophoblastic disease molar pregnancy
invasive mole
Gestational trophoblastic disease molar pregnancy
invasive mole
Gestational trophoblastic disease molar pregnancy
invasive mole
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 .
Ovarian problems
Normal position of IUCD
Pregnancy associated with IUCD
Thank you