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Assessing Normal and Abnormal Pregnancy From 4-10 Weeks: Monique Haak
Assessing Normal and Abnormal Pregnancy From 4-10 Weeks: Monique Haak
ISUOG’s basic training curriculum Source: The Virtual Human Embryo Project
Implantation-> gestational sac
weeks
Mean of 3 orthogonal planes
Growth in early pregnancy 1mm/day
ISUOG’s basic training curriculum Knez et al Best practice Reseach Clin O & G 2014;28:621-36
Yolk sac
• First structure identified within gestational sac
• Confirms intra uterine pregnancy, 100% PPV
• Spherical in shape
• Echogenic periphery
• Sonolucent center
• Attaches to embryo by vitelline duct
ISUOG’s basic training curriculum
Yolk sac
• Imaged ~ 5 - 5.5 w
• Imaged when MSD ~ 5-6 mm
• Imaged 3-5 d prior to embryo
• Diameter peaks at 6 mm at 10 w, then decreases
• Usually not visible after first trimester
• Number of yolk sacs usually equals number of amnions
ISUOG’s basic training curriculum
Yolk sac 0
5 and 74 weeks
73 w 92 w
Heartbeat use M-mode
55 w 74 w
Weeks
Heartbeat visible form CRL > 2-4 mm
Rapid frequency 5-9 weeks
Use M-mode
ISUOG’s basic training curriculum
Crown Rump Length (CRL)
• ISUOG guideline
• Midline sagittal section of whole fetus
• Ideal orientation horizontally
• Magnification fill most of width of screen
• Fetus in neutral position
• Amniotic fluid between chin and chest
• Endpoints clearly defined
ISUOG’s basic training curriculum ISUOG guideline 1st trim us scan UOG 2013;41:102-113
Embryo 6-8 weeks
64w 744w 84w
ISUOG’s basic training curriculum Knez et al Best Practice Res Clin O & G 2014;28:621-636
Terminology early pregnancy events 1
Terminology Comment
Viable Results in liveborn baby
Nonviable Cannot result in liveborn baby (failed intrauterine
pregnancy, ectopic pregnancy)
Intrauterine pregnancy TV ultrasound - intrauterine GS, no heartbeat
uncertain viability
Empty sac GS: absent structures, minimal debris, no heartbeat
Human chorionic gonadotropin Positive serum pregnancy test serum hCG > 5 IU/mL
24 mm
8 weeks no heartbeat
200000
150000 P95
IE/L
median
100000 P5
50000
0
3 4 5 6 7 8 9 10 12 14 16 18
weeks
Early pregnancy: normal values of hCG
hCG (intact + ß-subunits)
250000
150000
P95
IE/L
median
P5
100000
50000
3000
2500
2000
IE/L
P95
1500 median
P5
1000
500
0
3 4 5 6
weeks
ISUOG’s basic training curriculum
Ectopic right fallopian tube
LMP 8 weeks
Intrauterine Ectopic
ISUOG’s basic training curriculum Maruotti & Russo Fert Ster 2010;94:e49
Management Protocol – Pregnancy Unknown Location (PUL)
Progesterone ß-hCG
(nmol/L) (IU/L) Likely diagnosis Management
< 20 >25 Spontaneous resolving pregnancy Check urine or serum ß-
hCG in 7 days
20-60 >25 Unviable or ectopic pregnancy with Check serum ß-hCG in 2
moderate risk requiring days
intervention
>60 <1500 Normal intrauterine pregnancy Repeat scan when ß-
hCG expected > 1000
>60 >1500 Ectopic pregnancy with high risk Repeat scan same day
requiring intervention by senior examiner
HCG 330.000IU/L
Complete Partial
Prevalence 1:1500-2000 Prevalence 1:700
46, XX only paternal 69 XXX of 69 XXY (triploïdy), paternal and maternal
Persisting throphoblast 15% 2%
ISUOG’s basic training curriculum
Hydatiforme mole in twin pregnancy
• Blood loss and abdominal pain 8 weeks
• US dichorionic twin pregnancy of which 1 mola
• hCG 439.467 IU/l
• Counseling: miscarriage, hypertension, preeclampsia, thyroid disease,
persistent trophoblast disease, lung metastases
Prevalence 1:10000-100.000
ISUOG’s basic training curriculum
Accuracy of US diagnosis
Histology:
CHM PHM
Accuracy US
95% 20%
Histology:
non molar failed pregnancy
• 1:2000 zwangerschappen