first trimester ultrasound

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