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First trimester ultrasound

first trimester problems ... a simplified way of explanation

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First trimester ultrasound

  1. 1. First trimester ultrasound Dr. Kosar Kamal Ahmed H.D diagnostic radiology Lecture 2
  2. 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
  3. 3. 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 .
  4. 4. General considerations
  5. 5. General considerations
  6. 6. General considerations How to measure GS ? Calipers should be placed from in to in
  7. 7. 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
  8. 8. Problems of early pregnancy Miscarriage ( abortion ) Spontaneous abortion Threatened abortion Missed abortion Blighted ovum Complete abortion Incomplete abortion Traumatic abortion
  9. 9. Problems of early pregnancy Ectopic pregnancy Gestational trophoblastic disease Ovarian problems Uterine fibroids Pregnancy with IUCD
  10. 10. 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 pain
  11. 11. Ultrasound diagnosis of miscarriage According to ultrasound findings , miscarriage is classified into : Threatened Missed Incomplete Complete ( history of V. bleeding + live embryo seen by US ) ( absence of cardiac activity in fetal pole ) ( V. bleeding , cramps + RPOC ) ( V. bleeding , cramps + thin ndometrium “ no RPOC “
  12. 12. Ultrasound diagnosis of miscarriage threatened abortion
  13. 13. 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
  14. 14. Ultrasound diagnosis of abortion complete abortion Complete abortion V. bleeding , cramps + empty uterine cavity with thin endometrium Note : pregnancy should be proven .
  15. 15. Ultrasound diagnosis of abortion incomplete abortion RPOC Persistent V. bleeding , cramps decresed + finding of RPOC
  16. 16. Ultrasound diagnosis of abortion incomplete abortion RPOC
  17. 17. Ultrasound diagnosis of abortion incomplete abortion RPOC
  18. 18. Ultrasound diagnosis of abortion incomplete abortion RPOC
  19. 19. Ectopic pregnancy Is implantation of the GS any where outside the endometrial cavity .
  20. 20. Ectopic pregnancy Is a life threatening condition which if not diagnosed may lead to internal bleeding and death Abdominal pain +/- vaginal bleeding Shock
  21. 21. Ectopic pregnancy
  22. 22. Ectopic pregnancy ultrasound findings
  23. 23. Ectopic pregnancy ultrasound findings - About 26 % of ectopic pregnancies have a normal US examination - A potential pitfall is pseudo GS
  24. 24. Ectopic pregnancy ultrasound findings
  25. 25. Ectopic pregnancy ultrasound findings Scar pregnancy
  26. 26. Gestational trophoblastic disease molar pregnancy
  27. 27. Gestational trophoblastic disease molar pregnancy clinical features
  28. 28. Gestational trophoblastic disease molar pregnancy clinical features
  29. 29. Gestational trophoblastic disease molar pregnancy
  30. 30. Gestational trophoblastic disease molar pregnancy complete mole
  31. 31. Gestational trophoblastic disease molar pregnancy complete mole
  32. 32. Gestational trophoblastic disease molar pregnancy partial mole
  33. 33. Gestational trophoblastic disease molar pregnancy partial mole
  34. 34. Gestational trophoblastic disease molar pregnancy invasive mole
  35. 35. Gestational trophoblastic disease molar pregnancy invasive mole
  36. 36. Gestational trophoblastic disease molar pregnancy invasive mole
  37. 37. 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 .
  38. 38. Ovarian problems
  39. 39. Normal position of IUCD
  40. 40. Pregnancy associated with IUCD

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