1st trimester scan

18 de Jan de 2014

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1st trimester scan

  1. Basic ultrasound in O&G
  2. Why scan? Pregnancy Mass per abdomen Screening procedure - Pap smear, abd scan Liver/gallbladder Kidney/ bladder
  3. Pregnancy scanning Confirmation of pregnancy: POA UPT Scan
  4. Pregnancy scanning Dating of pregnancy: 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. of fetuses/ 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: 1st trimester 2nd trimester 3rd trimester Placenta: Error in localisation Probe Wait > 34/52
  8. Pregnancy scanning Sex Growth scan: BPD/AC/HC/wt Liquor volume-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: uterine fibroid, adenomyosis, polyp Cervix: fibroid, polyp Ovarian: cyst, mass Infertility work up: vaginal probe
  11. 1st trimester u/s Confirmation of 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: size and shape of GS CRL FH
  13. 1st trimester u/s No. of fetuses Nuchal translucency Dating of pregnancy
  14. Dating of pregnancy Abdominal method: Full bladder in early pregnancy: Pushes uterus out of pelvis Acoustic window Displaces bowel superiorly
  15. Dating of pregnancy Holding of probe (alignment): Maternal bladder on the right Fundus on the left
  16. Dating of pregnancy Embryo 37 days
  17. Dating of pregnancy Head discriminated against torso: 7w+3d 8 weeks: Movements with limbs
  18. Dating of pregnancy Accuracy of dating- When biological variability is minimal: CRL is more accurate than BPD But can be the most difficult measurement to obtain Dependant on operator
  19. 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
  20. Dating of pregnancy After 12w ++flexion --> delay after 15w
  21. Nuchal translucency Between 11-14w For chromosomal 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
  22. Nuchal translucency Measurement
  23. Problems of early pregnancy Miscarriage Ectopic pregnancy Abdominal pregnancy Trophoblastic disease Ovarian probs in early pregnancy Uterine fibroids Pregnancy with IUCD
  24. Problems of early pregnancy 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
  25. Miscarriage 20% incidence Threatened Missed Complete Incomplete
  26. Problems of early pregnancy Threatened miscarriage : PV bleed with live embryo 15% proceed to miscarriage Subchorionic haematoma # poor outcome
  27. Problems of early pregnancy 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
  28. Missed miscarriage
  29. Problems of early pregnancy Complete miscarriage: Thin endometrium Same as non pregnant uterus
  30. Complete miscarriage
  31. Problems of early pregnancy Incomplete miscarriage: Endometrial thickness between 5-15mm Combine diagnosis with clinical situation e.g VE
  32. Incomplete miscarriage
  33. Problems of early pregnancy Ectopic pregnancy: Implantation outside uterine cavity:93% tubal Incidence around 1% Presentation: classical, abd pain with PV bleeding, silent
  34. Problems of early pregnancy 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
  35. Problems of early pregnancy 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
  36. Problems of early pregnancy Ovarian: Mostly corpus luteum cyst- resolves <12w, usually < 5mm, single but can be complex Theca lutein cyst Dermoid cyst Benign cystadenoma Endometriomas