ASSESSMENT OF 1st

TRIMESTER CYESIS
BY
BODE ADEWUNMIPHD,FNIR
 GESTATIONAL SAC – (GS)
The earliest unequivocal sign of pregnancy using sonographic
evaluation is the demonstration of the gestational sac with
the new high- resolution real-time equipment, particularly
those equipped with Transvaginal probes. The gestational sac
can usually be seen by 5 menstrual weeks. At this early stage
in gestation, the average internal diameter of the gestational
sac, calculated as the mean of the Anterior-Posterior
diameter, the transverse diameter and the longitudinal
diameter
The gestational sac is an echo-free space containing fluid,
embryo, and extra embryonic structures. The sac is measured
inside the hyperechoic rim, including only the echo free
space.
The gestational sac is image first in the longitudinal plane,
obtaining long axis and anteroposterior measurements
perpendicular to each other. Then, in the transverse plane at
the level of anteroposterior measurements, the weight
measurement is obtained. The three measurements are
averaged to obtain the gestational sac mean diameter.
 NOTE
If MSD is very small about 2mm, gestational
age is 4 to 4 ½ inches. MSD of about 5mm is 5
weeks. At 5 ½ weeks, a yolk sac appears. At 6
weeks, an embryo first appears adjacent to
the yolk sac.
 CROWN-RUMP LENGTH {CRL}

Crown rump length (CRL) is a measurement of the embryo,

usually identified 6 to 7 weeks gestation. The embryo is
measured along its longest axis to obtain the CRL
measurement. Crown-rump length may be used to accurately
date pregnancy between 7 to 13 weeks’ gestation. The
technique involves measurement of the fetal length from the
tip of the cephalic pole to the tip of the caudal pole. The fetus
should be at rest and assuming its natural curvature.
 PATHOLOGY

THEARTENED ABORTION
1. May not be visible sonographically
2. Diagnosis is made whenever vaginal bleeding occur within
the first 20 weeks of pregnancy
3. Sonogram demonstrate a normal gestational
4. A perisac bleed may be seen
5. A low fetal cardiac rate of less than 100bpm suggest
impending death.
 INCOMPLETE ABORTION
1. If threatened abortion progresses,and some
products of conception are passed out as tissue
with bleeding
2. sono.- uterus appears enlarged ,there may be
empty ,ill-defined gestation within the uterus
3. Or a sac with internal echoes
4. Or large clumps of echoes within the
Endometrium representing part of fetus,
placenta,or blood.
 COMPLETE ABORTION
1. All products of conception is expelled
2. Sono-uterus appears enlarged,but with no
gestational sac or fetus
3. A central echo or prominent thickening of
central cavity is seen representing decidual
reaction or clot
4. Role is to confirm that the uterus is empty.
 MISSED ABORTION
1. Fetus dies but still retained within the uterus
2. Sono –uterus is small for expected data
3. It occurs between 6 and 14 weeks of
gestation
4. A gestational sac is seen with fetal pole but
no heart motion.
5. Diagnosis is made if a fetus measured about
5mm and no fetal heart motion is seen.
 BLIGTED OVUM
1. Anembryonic pregnancy
2. Sacs develops but no embryo
3. Sono –a gestational sac with loss of normal
double echogenic ring without a fetal pole
4. Failure to detect a double decidual sac at
MSD 10mm,Yolk sac at 20mm and embryo at
25mm.
5. Repeat scan in 2wks is also advised
 INEVITABLE ABORTION
1Patient come in with bleeding per vaginal
2 Sono –the area of the cervix may appear
widened and fluid filled owing to blood and
dilatation
3. A sonolucent space around the sac showing
dissected away from the uterine wall
4.Gestational sac may lie at the level of the
cervix
 SEPTIC ABORTION
1.Infected products of conception
2.Sono –uterus is enlarged,with increased
endometrial echos
3.If infection is caused by gass forming
organisms areas of shadowing may be
produced.
 HYDERTIDIFORM MOLE
1. Vaginal bleeding, excessive vomiting and high
blood pressure suggest the presence of a
mole.
2. Sono-the uterus will be filled with echoes
interspersed with few echopenic areas
3.HCG titers will be markedly elevated
4.Large cysts may be seen within the ovaries
representing theca lutein cyst.
 CHORIOCARCINOMA
1. Molar tissue has the potential to develop into
an aggressive malignancy known as
choriocarcinoma
2. Sono –the tumor has cystic centers with
echogenic borders
3. Also check liver for metastatic lesion.
4. Positive pregnancy test with very high HCG
 ECTOPIC GESTATION
1. A gestational sac in the adnexa containning a
fetal pole with heart motion
2. Enlarged uterus
3. A desidual reaction may be seen within the
endometrial cavity
4. An adnexal mass
5. Free fluid in the pelvis
6. Intra abdominal blood
THANK YOU!