Early Pregnancy- Dorma Ghana
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Transcript of Early Pregnancy- Dorma Ghana
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Early Pregnancy
Dr S ChawlaDorma, GhanaNovember 2013
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Role of US in Early pregnancy
Confirm:• Presence of live intra-uterine pregnancy• Gestational age• Number of fetuses
Exclude:• Early pregnancy failure• Ectopic pregnancy• Molar pregnancy• Other pathology
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Technique
Transabdominal scan• 3.5 – 5 MHz• Full bladder• Entire pelvis visible
Transvaginal scan• 7.5 MHz• Empty bladder• 8 – 10 cm depth
only
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Technique
• Begin in LS plane• Use wide FOV• Identify bladder• Look for gestation sac• Look for yolk sac or embryo• Check for heart pulsatations• Transverse• Scan out towards both adnexa
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Anatomy
Bladder
Cervix
Body ofUterus
Gestation sac
Sac containing yolk sac andFetal pole
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Estimating gestational age
1. Gestational sac size
Add 3 measurements, divide by 3, add 30, divide by 7
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Estimating gestational age
2. Crown rump length (CRL)
• Zoom the image• Find the longest axis of the embryo• Measure from crown to rump
• If CRL > 85mm, measureHC instead
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Early pregnancy abnormalities
• Embryonic demise• Multifetal pregnancy• Retained products of conception• Molar pregnancy • Ectopic pregnancy• Subchorionic haemorrhage• Some fetal abnormalities
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Embryonic demise (EPF)
1. Empty sac sign• MSD > 20mm with no visible yolk sac
CAUSES:• Missed miscarriage• Anembryonic pregnancy• Pseudo sac from ectopic pregnancy
20mm
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Embryonic demise (EPF)
2. Absent fetal heart pulsatation
• Embryo CRL > 10mm with no FH = EPF(Transabdominal)
If unsure:• Use M mode• Use Doppler• Get a second opinion
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Ectopic pregnancy (1)
• Implantation of pregnancy outside endometrium• 0.3-1.6% of pregnancies, 10% of maternal deaths• Role of ultrasound is to locate pregnancy• Intra-uterine pregnancy = ectopic excluded
IMPORTANT FACTS:• Normal ultrasound does not exclude ectopic• Must be correlated with clinical findings• ß-hCG > 1000 iu = embryo should be visible• If the patient is collapsed, do not delay treatment
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Ectopic pregnancy (2)Possible ultrasound features of ectopic
Intra-uterinepseudo sac
Solid adnexalmass with ‘doughnutappearance’
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Ectopic pregnancy (3)
Possible ultrasound features of ectopic
Thickened echobright endometrium
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Ectopic pregnancy (4)
Possible ultrasound features of ectopic
Solid adnexalmass
Bladder
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Ectopic pregnancy (5)
Possible ultrasound features of ectopic
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Molar pregnancy
• Present with bleeding and hyperemesis• Caused by excessive proliferation of
placental tissue• Occasionally fetal tissue forms (non-viable)• Elevated ßhCG levels• 10% develop into malignant choriocarcinoma
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Molar pregnancyAppearance of molar pregnancy
Enlarged echobright endometrium Multiple cystic spaces
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Retained products of conception
Echobright or heterogenous material within endometrial cavity
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Multifetal pregnancy
• Assess viability of all fetuses
• Identify presence or absence of dividing septum
• Look for lambda sign
THICK DIVIDING MEMBRANE = DCDA
THIN DIVIDING MEMBRANE= MCDA
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Associated findings• Intra-uterine fibroids
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Associated findings
• Ovarian cysts
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Early fetal abnormalities
• Anencephaly
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Early fetal abnormalities
• Megacystic baldder
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Early fetal abnormalities
• Gastroschisis/omphalocele
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Troubleshooting
To improve image quality:1. Ensure patient has full bladder2. Use multiple focal zones3. Narrow FOV and use zoom4. Use M mode, Doppler and Transvaginal
scanning if available
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TroubleshootingTo help visualise ovaries:• Use the bladder as a window
Scan right ovaryfrom the left
Scan left ovary from the right
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Face
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Nasal Bone
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Heart
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Kidneys
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Spine
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Limb
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Calvarium, choroids and midline
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Placenta
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Troubleshooting
REMEMBER:Always consider the clinical picture and
not just the ultrasound picture!