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FIRST TRIMESTER

ULTRASOUND

TVS advantages
Shorter probe-target distance
Allows use of higher frequency
probes
Better image resolution
Avoids problem of under/over
Earli
dx of fetal viability /
distended
er pregnan
ectopic
bladder
Ve
cy useful in retroverted
ry obese
uterusor

TVS disadvantages
Cost
Limited depth of
penetration Lacks
global picture
Difficulty in evaluation
of large masses
? Relatively invasive

LONGITUDINAL VIEW TA Bladde S r Uteru TV s S .

TRANSVERSE VIEW TA S TV S .

INDICATION First Trimester Ultrasound Screening Should be selective and restricted to specific indications .

Confirmation of pregnancy viability Established accurate gestational age Determine the number of fetuses Assess chorionicity and amniocity fetuses Imaging as an adjunct to chorionic villus sampling. and localization and removal of an intrauterine device . embryo transfer.

Common Indications Amenorrhoe a Pelvic pain Vaginal bleeding Unknown last normal menstrual dates Subjective feeling of pregnancy Uterus greater or smaller than dates on clinical evaluation .

?Last Menstrual Period The LMP is unreliable (and therefore Naegele’s formula cannot be used) if the: ●date of the LMP is not accurately known ●menstrual cycle is not 28 days long ●menstrual cycle is irregular ●woman has only stopped taking the combined oral contraceptive pill (‘the pill’) within the last 3 months ●woman has bled in early pregnancy ●woman is breast feeding or has been .

Pregnancy Development in Early TM Gestational Ultrasound Features weeks TVS TAS 4 4-5 gestational sac Round shape. internal cystic echo Two layers wall - 5 5-6 6-7 7-8 Embryo . fetal head.fetal pole and yolk sac Fetal heart beats.body and extremities are observed 8-9 9-10 Placenta and ventricles are seen .

Intrauterine GS .

IUGS vs Pseudosac pseudos ac IUG S .

Still CONFUSED??? .

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problem Should see on TVS Time of visualization Findings Gestation week Beta HCG or level measurement Gestation sac 5 menstrual weeks Yolk sac when MSD is >7mm Embryonic 5 weeks 2000 mIU/mL pole Fetal when CRL is >5 .

Estimation of Gestational Age .

Estimation of gestational age .

CROWN RUMP LENGTH .

Crown Rump Length (CRL) This measurement can be made between 7 to 13 weeks and gives very accurate estimation of the gestational age. Dating with the CRL can be within 34 days of the last menstrual period .

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MULTIPLE PREGNANCY

T
sign

Lambda
sign

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Failing Pregnancy/ Failure .

Diagnostic Signs of Early Pregnancy Failure in the First Trimester MSD of equal to or greater than 25 mm without an embryo Crown-Rump length of equal to or greater than 7 mm without cardiac activity Absence of embryo with heartbeat at 2 or more weeks after an ultrasound that showed a gestational sac without a yolk sac Absence of embryo with heartbeat .

TVS GS EMBRY > 7 O mm TAS > 25 mm without yolk sac > 9 mm .

Transvaginal ultrasound Embryo >5mm No cardiac activity Embryonic demise Embryo >9mm No cardiac activity Embryonic demise Gestational sac > 8 mm No yolk sac Gestational sac > 16 mm No embryo Blighted ovum Transabdominal ultrasound Gestational sac > 20mm No yolk sac Blighted ovum Gestational sac > 25 mm No embryo .

Early Trimester Pregnancy Development .

Thickened endometrium .

TA S TV S .

5 – 6 weeks .

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6 – 7 weeks .

7 – 8 weeks .

7 – 8 weeks .

9 weeks .

10 weeks .

Nuchal Translucency .

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chromosamal abnormality • Trisomy 21 or 18 or 13 • Turners Syndrome – Cardiac abnormality – Prediction of TTTS (4 fold increase in risk) .NUCHAL TRANSLUCENCY (NT) • 11 to 14 wks • =/> 3 mm • Abnormal NT may indicates: – 1.

• • • • • • • • First Trimester Fetal Defect Acrania/Anencephaly Holoprosencephaly Encephalocele Dandy-walker Syndrome Univentricular heart Gastrochisis Exomphalos Multidysplastic kidneys .

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Should First Trimester US be routine? Determination of EDD Optimise the time for fetal anomaly scan Enhance performance of serum screening test H/O ectopic pregnancy/miscarriage Intrauterine / ongoing pregnancy Diagnosed early unanticipated miscarriage Better informed when to deliver which complication arise in second or third trimester Minimise false positive IOL for postmaturity Multiple pregnancy and .

Ectopic pregnancy .

Adnexal Mass • 35 .50% with TAS • 95% with TVS • Gestational sac with viable embryo in fallopian tube (12%) • complex mass high sensitivity (98%) .

Fluid in POD Not seen in 20% of ectopics May be seen in normal patients .

Failure to visualize intrauterine GS consider patient not pregnant early pregnancy ectopic pregnancy Use beta hCG Must see IUGS with TVS if hCG .

800 mIU/L .000 mIU/L Gestational sac with yolk sac 5.GUIDELINES FOR DATING PREGNANCY STAGE OF GESTATIO.200 mIU/L Gestational sac with yolk sac & embryo 6 weeks 10.5 weeks 7.000-2.LEVEL OF BDEVELOPM ENT NAL AGE (WEEKS) HCG Gestational sac 5 weeks 1.

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Molar pregnancy .

Complete Mole .

Snowstorm Appearance .

Theca Lutein Cyst in Molar Pregnancy .

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Biometric Measurements of the Basic Obstetric Mean sac diameter if no embryo is seen Ultrasound Examination Crown-Rump Length up to 13 6/7 weeks gestation Biparietal Diameter >13 6/7 weeks gestation Head Circumference >13 6/7 weeks gestation Abdominal Circumference >13 6/7 weeks gestation Femur Length >13 6/7 weeks gestation .

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THANK YOU .