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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5841_Библиотеки_им_академика_М_И_Перельмана
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First Trimester 19
9. To identify any gross anomalies
a
. Gross abnormalities of the cranium, spine,
abdomen and limbs can be detected even in the
late first trimester.
Fig. 3.7: Measurement of crown rump length in
a 7 weeks and 6 days embryo
Fig. 3.8: Measurement of crown rump length in an
11 weeks and 6 days fetus
20 Step by Step Ultrasound in Obstetrics
b. Nasal bone ossification
c. Nuchal Translucency
Fig. 3.9: Heart rate of 92 beats per minute in a
5 weeks and 5 days embryo
Fig. 3.10: Heart rate of 174 beats per minute in an
8 weeks and 1 day fetus
First Trimester 21
10. Color Doppler evaluation of the ductus venosus and
both maternal uterine arteries
Fig. 3.11: Wrapping around thick trophoblastic reaction seen
in a gestational sac of 6 weeks 5 days
Fig. 3.12: Note the thickened trophoblastic echoes (star) on one
wall of the gestational sac. This is the placental site location
22 Step by Step Ultrasound in Obstetrics
Fig. 3.13: The placenta is anterior with an amnio-decidual
separation seen in the anterior wall superior to the cervix. This
has an associated collection of 8.35 ml
Fig. 3.14: Multiple foci of chorio-decidual separation seen in
a 06-07 weeks size missed abortion
First Trimester 23
3.3 NORMAL PARAMETER EVALUATION
IN THE FIRST TRIMESTER
1. Gestational sac seen as early as 4½ weeks by trans-
vaginal scan and 5½weeks by transabdominal scan (Fig.
3.15)
2.
Y olk sac: seen as early as 5 weeks by transvaginal scan
and 6 weeks by transabdominal scan (Fig. 3.16)
3. Embryo: seen at 5½ weeks by transvaginal scan and at
6-6½ weeks by transabdominal scan (Fig. 3.17)
4. Cardiac activity: appears at 5 weeks and 4 days
3.4 ABNORMAL INTRAUTERINE PREGNANCY
1. No embryonic cardiac activity with a CRL > 5 mm.
(Missed Abortion) (Fig. 3.18)
2.
Gestational sac larger than 8 mm without a yolk sac.
(Blighted Ovum) (Fig. 3.19)
3. Gestational sac larger than 16 mm without an embryo.
(Anembryonic Pregnancy) (Fig. 3.20)
4. Abnormally large or irregular or small amniotic sac
(Fig. 3.21)
3.5 IMPENDING EARLY PREGNANCY FAILURE
1. Embryonic bradycardia relative to CRL
2
. Mean sac diameter minus CRL is less than 5 mm (oligo-
amniotic sac)
3. Poor sac growth
4. Large (> 5.6 mm prior to 10 weeks) /abnormal yolk sac
(Figs 3.22 and 3.23)
5. Disappearance of the corpus luteum
24 Step by Step Ultrasound in Obstetrics
Fig. 3.15: Transvaginal scan of a gestational sac
of 05 weeks size
Fig. 3.16: Gestational sac of 5 weeks and 2 days with a
yolk sac clearly delineated (solid line)
Classification of Early Pregnancy Loss
Stage A
•
Loss withing first 2 weeks
First Trimester 25
Fig. 3.17: Pregnancy of 5 weeks and 6 days gestation showing
a yolk sac (solid line) and an embryo (dotted line)
Fig. 3.18: No cardiac activity seen in this 08 mm pulseless
attenuated embryo
• Subclinical loss
• No sonographic evidence
26 Step by Step Ultrasound in Obstetrics
Fig. 3.19: Thin-walled gestational sac of 15 mm in the uterine
fundus with no embryo or yolk sac seen
Fig. 3.20: Seven weeks gestational sac showing
a yolk sac but no embryo
Stage B
• Loss at 05-06 weeks
• Empty gestational sac
First Trimester 27
Fig. 3.21: Large, flaccid and irregular amniotic sac
with a pulseless embryo
Fig. 3.22: Large yolk sac with the embryo seen adjacent to it
28 Step by Step Ultrasound in Obstetrics
Fig. 3.23: Shrunken yolk sac with an extensive cystic
hygroma associated with it
Stage C
• Loss at 07-08 weeks
• Abnormal gestational sac and embryo
Stage D
• Loss at 09-12 weeks
• Abnormal embryo
3.6 ECT OPIC GESTATION
1. Demonstration of live embryo in the adnexa is
diagnostic of ectopic pregnancy (Fig. 3.24)
2.
Nonspecific findings of an ectopic pregnancy are an
adnexal mass (Fig. 3.23), free fluid (Fig. 3.25), a tubal
ring (Fig. 3.26) and identification of adnexal peri-
trophoblastic flow (Fig. 3.27)
3. Vascular ring can be delineated (Fig. 3.28)
4. The blood flow characteristically shows low-
impedance, high-diastolic flow
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