FIRST TRIMESTER

ULTRASOUND

TVS advantages
Shorter probe-target distance
Allows use of higher frequency
probes
Better image resolution
Avoids problem of under/over
Earli
dx of fetal viability /
distended
er pregnan
ectopic
bladder
Ve
cy useful in retroverted
ry obese
uterusor

TVS disadvantages
Cost
Limited depth of
penetration Lacks
global picture
Difficulty in evaluation
of large masses
? Relatively invasive

LONGITUDINAL VIEW
TA
Bladde
S
r
Uteru
TV
s
S

TRANSVERSE
VIEW
TA
S

TV
S

INDICATION

First Trimester Ultrasound

Screening
Should be selective and
restricted to
specific indications

Confirmation of pregnancy viability

Established accurate gestational age
Determine the number of fetuses
Assess chorionicity and amniocity
fetuses
Imaging as an adjunct to chorionic
villus sampling, embryo transfer, and
localization and removal of an
intrauterine device

Common Indications
Amenorrhoe
a Pelvic pain
Vaginal
bleeding
Unknown last normal
menstrual dates Subjective
feeling of pregnancy
Uterus greater or smaller than
dates on clinical
evaluation

?Last Menstrual Period

The LMP is unreliable (and therefore
Naegeles formula cannot be used) if
the:
date of the LMP is not accurately
known
menstrual cycle is not 28 days long
menstrual cycle is irregular
woman has only stopped taking the
combined oral contraceptive pill (the
pill) within the last 3 months
woman has bled in early pregnancy
woman is breast feeding or has been

Pregnancy Development in Early

TM
Gestational
Ultrasound Features
weeks

TVS

TAS

4-5

gestational sac
Round shape, internal cystic echo
Two layers wall -

5
5-6

6-7
7-8

Embryo - fetal pole and yolk sac

Fetal heart beats, fetal head,body
and extremities are observed

8-9

9-10

Placenta and ventricles are seen

Intrauterine GS

IUGS vs Pseudosac

pseudos
ac

IUG
S

Still CONFUSED???

problem
Should see on TVS Time of
visualization
Findings
Gestation week Beta HCG
or
level
measurement
Gestation sac 5 menstrual
weeks
Yolk sac
when MSD is
>7mm
Embryonic
5 weeks
2000 mIU/mL
pole
Fetal
when CRL is >5

Estimation of Gestational
Age

Estimation of gestational
age

CROWN RUMP LENGTH

Crown Rump Length

(CRL)
This measurement can be made
between 7 to 13 weeks and gives
very accurate estimation of the
gestational age.
Dating with the CRL can be within 34 days of the last menstrual period

MULTIPLE PREGNANCY

T
sign

Lambda
sign

Failing Pregnancy/
Failure

Diagnostic Signs of Early Pregnancy Failure

in the First Trimester

MSD of equal to or greater than 25

mm
without an embryo
Crown-Rump length of equal to or
greater
than 7 mm without cardiac activity
Absence of embryo with heartbeat
at 2 or more weeks after an
ultrasound that
showed
a gestational sac without a yolk sac
Absence of embryo with heartbeat

TVS
GS
EMBRY > 7
O
mm

TAS
> 25 mm without
yolk
sac
> 9 mm

Transvaginal
ultrasound

Embryo >5mm
No cardiac
activity
Embryonic
demise

Embryo >9mm
No cardiac
activity
Embryonic
demise

Gestational sac > 8

mm
No yolk sac

Gestational sac >

16 mm
No embryo

Blighted
ovum

Transabdominal
ultrasound

Gestational sac >

20mm No yolk sac

Blighted
ovum

Gestational sac >

25 mm No embryo

Early Trimester
Pregnancy
Development

Thickened endometrium

TA
S

TV
S

5 6 weeks

6 7 weeks

7 8 weeks

7 8 weeks

9 weeks

10 weeks

Nuchal Translucency

NUCHAL TRANSLUCENCY (NT)

11 to 14 wks
=/> 3 mm
Abnormal NT may
indicates:
1. chromosamal abnormality
Trisomy 21 or 18 or 13
Turners Syndrome

Cardiac abnormality
Prediction of TTTS (4 fold
increase in risk)

First Trimester Fetal

Defect

Acrania/Anencephaly
Holoprosencephaly
Encephalocele
Dandy-walker Syndrome
Univentricular heart
Gastrochisis
Exomphalos
Multidysplastic kidneys

Should First Trimester US be

routine?
Determination of EDD
Optimise the time for fetal anomaly
scan Enhance performance of
serum screening test H/O ectopic
pregnancy/miscarriage Intrauterine /
ongoing pregnancy
Diagnosed early unanticipated
miscarriage Better informed when to
deliver which complication arise in
second or third trimester Minimise
false positive IOL for postmaturity
Multiple pregnancy and

Ectopic pregnancy

Adnexal Mass
35 - 50% with TAS
95% with TVS
Gestational sac with viable
embryo in
fallopian tube (12%)
complex mass high sensitivity
(98%)

Fluid in POD

Not seen in 20% of ectopics

May be seen in normal patients

Failure to visualize
intrauterine GS
consider
patient not
pregnant early
pregnancy
ectopic
pregnancy Use
beta hCG
Must see IUGS
with TVS if hCG

GUIDELINES FOR DATING

PREGNANCY
STAGE
OF
GESTATIO- LEVEL OF BDEVELOPM
ENT

NAL AGE
(WEEKS)

HCG

Gestational sac

5 weeks

1,000-2,000
mIU/L

Gestational sac
with yolk sac

5.5 weeks

7,200 mIU/L

Gestational sac
with yolk sac &
embryo

6 weeks

10,800 mIU/L

Molar pregnancy

Complete Mole

Snowstorm Appearance

Theca Lutein Cyst in Molar

Pregnancy

Biometric Measurements of the Basic

Obstetric
Mean sac diameter
if no
embryo is seen
Ultrasound
Examination
Crown-Rump
Length

up to 13 6/7 weeks
gestation

Biparietal Diameter

>13 6/7 weeks gestation

Head
Circumference

>13 6/7 weeks gestation

Abdominal
Circumference

>13 6/7 weeks gestation

Femur Length

>13 6/7 weeks gestation

THANK
YOU