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1st trimester scan
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- 2. Why scan? Pregnancy Mass perabdomen Screening procedure - Pap smear, abd scan Liver/gallbladder Kidney/ bladder
- 3. Pregnancy scanning Confirmation ofpregnancy: POA UPT Scan
- 4. Pregnancy scanning Dating ofpregnancy: 4-5th week: GS 6th week: GS, Fetal echo, FH 7-12th week: CRL 12-24th week: BPD/HC/AC/FL +/- 2/52 After 24 weeks: 3/52 error To change EDD???
- 5. Pregnancy scanning No. offetuses/ sacs Viability of fetuses: Out of sync Wrong dates Missed abortion Incomplete abortion Molar pregnancy
- 6. Pregnancy scanning Ectopic pregnancy: History UPT Complaints-symptoms Signs- classical, silent, leaking USS-by exclusion, vaginal probe, fluid in POD
- 7. Pregnancy scanning Abnormality scan: 1sttrimester 2nd trimester 3rd trimester Placenta: Error in localisation Probe Wait > 34/52
- 8. Pregnancy scanning Sex Growth scan: BPD/AC/HC/wt Liquorvolume-AFI Charts
- 9. Pregnancy scanning Abnormal lie/presentation: Breech Transverse Unstable Post-partum: Hemorrhage/retained placenta Sepsis Uterus = 12/52 at 12/7
- 10. Gynaecological scanning Uterus: uterinefibroid, adenomyosis, polyp Cervix: fibroid, polyp Ovarian: cyst, mass Infertility work up: vaginal probe
- 11. 1st trimester u/s Confirmationof pregnancy: Earliest by scan: 4w3d-vaginal probe (2-3mm) 5w3d -abdominal probe Presence of GS with fetal echo FH + by 6/52
- 12. 1st trimester u/s Viability: sizeand shape of GS CRL FH
- 13. 1st trimester u/s No.of fetuses Nuchal translucency Dating of pregnancy
- 14. Dating of pregnancy Abdominalmethod: Full bladder in early pregnancy: Pushes uterus out of pelvis Acoustic window Displaces bowel superiorly
- 15. Dating of pregnancy Holdingof probe (alignment): Maternal bladder on the right Fundus on the left
- 18. Dating of pregnancy Embryo37 days
- 19. Dating of pregnancy Headdiscriminated against torso: 7w+3d 8 weeks: Movements with limbs
- 20. Dating of pregnancy Accuracyof dating- When biological variability is minimal: CRL is more accurate than BPD But can be the most difficult measurement to obtain Dependant on operator
- 22. Dating of pregnancy Eg:between 5-7 weeks can be inaccurate Full length of embryo not obtained End points not separate from yolk sac or not included From 9w: any flexion- can underestimate
- 24. Dating of pregnancy After12w ++flexion --> delay after 15w
- 25. Nuchal translucency Between 11-14w Forchromosomal abnormalities-principally trisomy 21 An increased collection of subcutaneous fluid (NT) behind the neck Structural abnormalities, genetic cond, cardiac abnormalities Numerical cut off in relation to gestational age Adjusted to maternal age, CRL and NT
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- 27. Problems of earlypregnancy Miscarriage Ectopic pregnancy Abdominal pregnancy Trophoblastic disease Ovarian probs in early pregnancy Uterine fibroids Pregnancy with IUCD
- 28. Problems of earlypregnancy Hormonal measurement (HCG) Monoclonal antibody based UPT can detect >25 iu/L = 2425/7 of a normal 28/7 cycle (i.e before one misses the period) Serum HCG doubles every 2/7 Combine w USS: no intrauterine preg, no doubling Of HCG in 2-3/7, or cut off point of 1000iu/L
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- 30. Problems of earlypregnancy Threatened miscarriage : PV bleed with live embryo 15% proceed to miscarriage Subchorionic haematoma # poor outcome
- 31. Problems of earlypregnancy Missed miscarriage: Early featal death but retained GS RCOG: absence of cardiac activity when CRL > 6mm Absence of yolk sac or embryo when CTS > 20mm If less than above, repeat after 1/52
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- 33. Problems of earlypregnancy Complete miscarriage: Thin endometrium Same as non pregnant uterus
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- 35. Problems of earlypregnancy Incomplete miscarriage: Endometrial thickness between 5-15mm Combine diagnosis with clinical situation e.g VE
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- 37. Problems of earlypregnancy Ectopic pregnancy: Implantation outside uterine cavity:93% tubal Incidence around 1% Presentation: classical, abd pain with PV bleeding, silent
- 38. Problems of earlypregnancy Ectopic pregnancy: Ultrasound findings: UPT positive with empty uterus With vaginal probe 85% can be visualised Pseudo sac--> 10-30% of ectopic Presence of fluid in POD--> 20-25% of ectopic
- 39. Problems of earlypregnancy Trophoblastic disease: Spectrum: benign- hydatidifom mole, malignantchoriocarcinoma Complete hydatidifom mole- snow storm appearance, no fetal tissue, serum HCG high Partial hydatidifom mole- trophoblastic hyperplasia w fetal tissue
- 40. Problems of earlypregnancy Ovarian: Mostly corpus luteum cyst- resolves <12w, usually < 5mm, single but can be complex Theca lutein cyst Dermoid cyst Benign cystadenoma Endometriomas