Item1c_First Trimester Part 3

Slide 1:

First Trimester Ultrasound Alfred Abuhamad, MD. International Society for Ultrasound in Obstetrics & Gynecology

Goals of 1st Trimester Ultrasound:

Goals of 1 st Trimester Ultrasound Determine location of pregnancy Determine whether embryo is living or not Determine accurate dating of pregnancy

Indications for 1st Trimester Ultrasound:

Indications for 1 st Trimester Ultrasound Maternal pain or bleeding Unknown menstrual dates Uterine size greater / smaller thn dates

Ectopic Pregnancy:

Ectopic Pregnancy

Ectopic Pregnancy:

Ectopic Pregnancy

Ectopic Pregnancy:

Ectopic Pregnancy Ampullary portion (75-80%) Isthmic portion (10%) Fimbrial portion (5%) Interstitial/cornual (2-4%) Ovarian (0.5%) Locations

Ectopic Pregnancy:

Ectopic Pregnancy Callen

Ectopic Pregnancy:

Ectopic Pregnancy History of tubal surgery ▲ ▲ ▲ History or prior ectopic ▲ ▲ Use of IUD ▲ ▲ History of infertility ▲ Lancet 1998;351:1115 Risk Factors

Ectopic Pregnancy:

Ectopic Pregnancy Right or left sided pelvic pain Vaginal bleeding Adnexal mass Patient’s Symptoms

Ectopic Pregnancy:

Ectopic Pregnancy Symptomatic ovarian mass Pelvic inflammatory disease Dysfunctional uterine bleeding Spontaneous abortion Differential Diagnosis

Ectopic Pregnancy:

Ectopic Pregnancy Do a pregnancy test, if + Look at the endometrial cavity by endovaginal ultrasound Step One

Ectopic Pregnancy:

Ectopic Pregnancy A gestational sac in the endometrial cavity practically rules out an ectopic pregnancy The incidence of heterotopic pregnancy is 1/7000 Step One

Ectopic Pregnancy:

Ectopic Pregnancy Step One No IUP noted, thick endometrium

Ectopic Pregnancy:

Ectopic Pregnancy Step One Blood in cavity, not a gestational sac (Pseudosac)

Ectopic Pregnancy:

Ectopic Pregnancy Step One Blood in cavity, not a gestational sac (Pseudosac)

Ectopic Pregnancy:

Ectopic Pregnancy Look at the cul-de-sac and pelvis for free fluid, which may indicate intra-abdominal bleeding Step Two

Ectopic Pregnancy:

Ectopic Pregnancy Step Two Free fluid in cul-de-sac (?bleeding) Blood clot

Ectopic Pregnancy:

Ectopic Pregnancy Step Two Free fluid in pelvis (?bleeding) Blood clot

Slide 19:

Ectopic Pregnancy

Ectopic Pregnancy:

Ectopic Pregnancy Look at the adnexal regions, for fluid (blood) and for the ectopic gestational sac Step Three

Ectopic Pregnancy:

Ectopic Pregnancy Step Three Left Ovary Ectopic gestational sac

Ectopic Pregnancy:

Ectopic Pregnancy Step Three Echogenic rim

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Pseudosac in endometrial cavity Ectopic gestational sac

Slide 24:

Color and pulsed Doppler is not helpful in diagnosis

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Sac in lower segment / in C/S scar Ectopic Pregnancy

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Sac in lower segment / in C/S scar Ectopic Pregnancy Bladder

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Cervical ectopic pregnancy Sac in lower segment / cervical canal Ectopic Pregnancy

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Cervical ectopic pregnancy Sac in lower segment / cervical canal Ectopic Pregnancy

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Cornual ectopic pregnancy Ectopic Pregnancy Empty Uterus

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Cornual ectopic pregnancy Ectopic Pregnancy Cornual Pregnancy at 12 weeks / twins Uterus

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Cornual ectopic pregnancy Ectopic Pregnancy

Ectopic Pregnancy:

Ectopic Pregnancy Follow-up is critical if you cannot make a diagnosis. Repeat ultrasound in 5-7 days if needed. Step Four

Ovarian Cysts:

Ovarian Cysts Can cause symptoms similar to ectopic Corpus Luteum

Ovarian Cysts:

Ovarian Cysts Can cause symptoms similar to ectopic Corpus Luteum

Ovarian Cysts:

Ovarian Cysts Can cause symptoms similar to ectopic Hemorrhagic cyst

Ovarian Cysts:

Ovarian Cysts Can cause symptoms similar to ectopic Endometrioma

Ovarian Cysts:

Ovarian Cysts Can cause symptoms similar to ectopic Dermoid Cyst

Other Benefits of First Trimester Ultrasound:

Other Benefits of First Trimester Ultrasound

Early Diagnosis of Chorionicity (Twins):

Early Diagnosis of Chorionicity (Twins) The early diagnosis of chorionicity enables practitioners to better identify multiples at high risk for poor outcomes. Ultrasound assessment of chorionicity has a high sensitivity and specificity. This is further improved if the assessment is performed prior to 14 weeks' gestation. Monochorionic Diamniotic Dichorionic Diamniotic

First Trimester Ultrasound:

First Trimester Ultrasound Yolk Sac & Twinning 1 Yolk Sac ----- Mo/Mo 2 Yolk Sacs ----- Mo/Di or Di/Di J Ultra Med, 1995;14:415 # of Yolk Sacs = # of Amnions

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Yolk Sac & Twinning

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Placenta Previa Cervix Placenta

Abnormal Fetal Anatomy in First Trimester:

Abnormal Fetal Anatomy in First Trimester

Early Diagnosis of Anomalies:

Early Diagnosis of Anomalies A portion of fetal abnormalities can be detected on 1 st trimester ultrasound. 1,690 fetuses underwent 1st and 2 nd trimester ultrasound screening for anomalies, 54% anomalies detected in 1 st trimester Omphalocele Anencephaly

1st Trimester Cystic Hygroma:

1 st Trimester Cystic Hygroma

Slide 46:

1 st Trimester Conjoined twins