Website : Indonesia’s World Federation of Ultrasound in

Medicine - Centre of Education

Jakarta
Introduction, Indication & Screening US
at Trimester I

Dahono & Daniel Makes

World Federation of Ultrasound in Medicine & Biology – Center of

Education
( Indonesia’s WFUMB-COE )
 Introduction
 First three month of pregnancy.
 Most of the fetal development.
 The embryo is most susceptible from
external toxin, drugs and infection.
 The majority of congenital anomalies
during this time.
 Better visualisation with higher frequency
Transvaginal probes.
The first trimester that fetus is most vanurable
 Methods of ultrasound
assessment
 Trans-abdominal ultrasound ( TAS )

 Transvaginal ultrasound ( TVS )

 The aims of first trimester US
 Visualising and localising the GS.
 Estimating the gestasional age.
 Identifying embryonic demise and
anembryonic pregnancy.
 Indentifying embryo viability.
 Determining the number of
embryo.
 Early diagnosis of fetal
abnormality.
First Trimester Ultrasound Screening
 Pregnant ?
 Live ?
 Gestational age ?
 Intra or extra uterine ?
 blighted ovum ?
 Single ? Multiple ?
 Abortion ?
 Mola ?
 Pelvic mass ?
4 weeks - gestational sac
5 weeks - yolk sac
6 weeks - fetal heart pulsations
7 weeks - embryonic movements
8 weeks - head and limb buds
8 - 10 weeks - physiological omphalocoele
9 weeks - cord insertion
Early keys :
US sign Gestational age
GS 5-6 weeks
Fetal pole 6-7 weeks
Heart beat 7-8 weeks
Fetal movement 8-9 weeks
Placenta 8-10 weeks
Lost of the sac 11-13 weeks
BPD measurement 11-14 weeks
Early keys : US sign Gestation
al age
GS 5-6 weeks
Fetal pole 6-7 weeks
Heart beat 7-8 weeks
Fetal 8-9 weeks
movement
Placenta 8-10
weeks
Lost of the 11-13
sac weeks
BPD 11-14
measureme weeks
nt
 Gestasional
 The FirstSac
defenitive finding to suggest
early pregnancy.
 The size threshold 2-3 mm (4.5
week).
 Double decidual sac.
 Shape round, ellips.
 GS fundally located.
 Three orthogonal dimensions .
 Longitudinal, AP and tranversal/3.
Gestasional
sac
 GS Diameter

GS diameter=( longitudinal+AP+Transversal) : 3
 Yolk sac
 First anatomy structure identified within GS.
 By TV, visible initially 5th week (MSD 5mm).
 By TA, 7th week ( MSD 20 mm).
 Spherical, echogenis periphery and a
anechoic center.
 Visualising Before the fetus is seen and
disappears at 12 week
 Confirm that an intrauterine pregnancy.
 Yolk Sac.

Yolk sac
Yolk sac Corpus luteum
 The
Amnion.
 The amniotic membrane so thin ( 0,02-0,5
mm) it is not usually identified.
 Surrounded by the thick, echogenic
chorion.YS is situated between amnion
and chorion.
 Fusion with chorionic membrane at 12 th
week.
Amnion
 Embryo and cardiac
activity
 The threshold for embryo detection is 1-2mm.
 By TV US Cardiac activity, when embryo
length 4–5 mm.
 By TA US, cardiac activity should be evident
by 8 week.
 Cardiac rates vary with gestasional age.
 Measurement CRL has an accuracy ± 4
days.
 CRL length increases 1 mm/day.
Fetal Heart Movement ( FHM ) ( Doppler )
 Crown Rump Length ( CRL )
• The longest distance from vertex to rump
• Exclude the jolk sac and foot
• High accuracy < 12 weeks
CRL
Multiple Pregnancy
Missed Abortion
Blighted Ovum
Thin and irregular wall Serial US examination

No fetal echo at 25 mm of GS Compare with serum HCG

Subchorionic bleeding
Empty !
BLIGHTED OVUM
 INTRA UTERINE FETAL DEATH

Causes : placental (48.4%), fetal (22%), maternal

(2.3%), placental & maternal (1%), placental &
fetal (12.8%), and indeterminate (13.7%) (Volker,
1992 ; Merz, 2005)

Placental causes : chronic insufficiency (54%),

abruption (24.5%), chorioamnionitis (24.5%),
subclinical intervillositis (2.1%), and other causes
& combinations (3.2%) (Merz, 2005)
INTRA UTERINE FETAL DEATH
IUFD : 9 weeks EGA : 9 weeks
(normal)
ECTOPIC PREGNANCY

 Acute abdominal pain

 Shock
 Bleeding

 Intra-uterine finding will exclude the ectopic

pregnancy
 Pseudo-gestational sac
 Retro-uterine fluid collection
 Complex masses
 Adnexal mass (GS-fetal pole-FHR)
 ECTOPIC PREGNANCY on the right adnexa

No sign of intra-uterine
gestational sac
Molar Pregnancy

• Sometime no symptom
• Bleeding
• Snowstorm appearance
• Fetal pole
• Partial mole
• Invasive mole
Molar Pregnancy
 SUMMARY
 Calculate gestation from LMP
 Identify the uterus and gestasional sac.
 Look for FHM to confirm viability
 Exclude multiple pregnancy
 Check the adnexa
 Measure CRL
 Verify EDD
 Multiple pregnancy
Thank You