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Early Pregnancy Ultrasound – Normal Appearances and Complications

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First Trimester Ultrasound Evaluation
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Summary of the video:

Normal Progression in Early Pregnancy

  • 5-6 Weeks: Sequential visualization of endometrium, gestational sac, and yolk sac.
  • Signs of Normal Early Pregnancy: Presence of a small fetal pole and appropriately sized gestational sac.

Evaluation of Early Pregnancy Failure Criteria

  • Diagnostic Criteria: Crown-rump length (CRL) above 7mm without a detectable heartbeat, mean sac diameter equal to or exceeding 25mm without an embryo.
  • Follow-up Recommendations: After two weeks to confirm diagnostic findings and assess for progression.

Read this detailed article for NEJM criteria for early pregnancy failure:

Criteria for Early Pregnancy Failure – NEJM and SRU

Findings Indicative of Poor Prognosis

  • Irregular Gestational Sac: Possible sign of intracavitary hemorrhage.
  • Large yolk sac.
  • Small Gestational Sac: Cramped appearance indicating limited space for fetal development.
  • Large amnion
  • Bradycardia: Fetal heart rate below 90bpm suggesting a poor prognosis.

Miscarriage (Abortion) and its types

Comparison of different types of miscarriage including threatened, missed, inevitable, incomplete, and complete miscarriage.

Retained Products of Conception (RPoC)

  • Ultrasound Features: Thickened heterogeneous endometrium, presence of an endometrial mass.
  • Differential Diagnosis: Considerations include arteriovenous malformations (AVMs), RPoC, polyps, or submucosal fibroids based on imaging characteristics.

Gestational Trophoblastic Disease Spectrum

  • Benign vs. Malignant Conditions: Benign entities such as complete and partial moles characterized by elevated beta hCG levels.
  • Ultrasound Characteristics: Snowstorm or cluster of grapes appearance within the endometrium indicative of molar pregnancies.

Important Differential Diagnoses and Diagnostic Considerations

  • Ectopic Pregnancy: Absence of an intrauterine gestational sac with a separate adnexal mass warrants consideration for ectopic pregnancy.
  • Differentiating AVM from RPoC: Utilize Doppler vascularity to distinguish between arteriovenous malformations and retained products of conception.
  • Gestational Trophoblastic Disease: Evaluate for cystic changes and persistent elevation in beta hCG levels to differentiate from other conditions.

Key Points for Accurate Diagnosis

  • Location Confirmation: Distinguish between intrauterine and ectopic pregnancies for appropriate management.
  • Viability Assessment: Evaluate critical parameters such as CRL and sac size to determine pregnancy viability.
  • Dating Precision: Importance of accurate dating for timely intervention and decision-making in early pregnancy complications.

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