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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 pregnancy
abortion
Approximately 20 % of

women attending early

pregnancy units suffer a

miscarriage

Most women will present

with history of vaginal

bleeding and or abdominal


Ultrasound diagnosis of miscarriage
According to ultrasound

findings , miscarriage is

classified into : history of V. bleeding + live embryo seen by)

Threatened ( US

Missed ( absence of cardiac activity in fetal pole)

Incomplete (V. bleeding , cramps + RPOC)

Complete
V. bleeding , cramps + thin ndometrium )

no RPOC
Ultrasound diagnosis of miscarriage
threatened abortion
Ultrasound diagnosis of miscarriage
missed 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 pregnancy
ultrasound findings
Ectopic pregnancy
ultrasound findings
About 26 % of ectopic-

pregnancies have a

normal US examination

A potential pitfall is-

pseudo GS
Ectopic pregnancy
ultrasound findings
Ectopic pregnancy
ultrasound 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

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