NORMAL & ABNORMAL INTRA UTERINE PREGNANCY

FIRST TRIMESTER

4 WEEK INTRADECIDUAL SAC SIGN (IDSS)

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Intrauterine anechoic cyst seen @ 4 5 weeks on TVS. Indicates 1. Normal Pregnancy 2. Decidual Cyst 3. Pseudogestational sac Not definitive for pregnancy

Anechoic sac with a surrounding hyperechoic ring of decidual sac IDSS

DOUBLE DECIDUAL SAC SIGN

Black circle GS ,displacing the Uterine endometrium.White area thickened decidual tissue

Double decidual sac sign formed by Decidua Capsularis and Decidua Parietalis with fluid in endometrial cavity seen as an hypoechoic line separating the two hyperechoic decidual layers

DDS White arrow hyperechoic decidual reaction,Decidua Capsularis Black arrow uterine endometrial lining,Decidua Vera/parietalis The two hyperechoic lines indicate DDSS

NEGATIVE IDSS

Gestational sac surrounded by uterine endometrium Indicates : Abortion

Lower Uterine Segment gestational sac

Hour glass uterus can be seen Indicates 1. Cervical Pregnancy 2.Passing Abortion

DOPPLER

Normal Marked vascularity on Colour Doppler at the site of Implantation

Other characteristics of a normal intrauterine gestational sac include: 1.Continuous echogenic rim of at least 2 mm thickness, 2.spherical or ovoid shape, 3.location in the upper or middle portion of the uterus, and 4.growth >1.2 mm per day.

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WEEK

Gestational sac with Yolk sac Definite Indicator of Intrauterine Pregnancy

6 WEEK

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The Fetal Pole is seen along with Yolk Sac inside the Gestational Age.

Cardiac activity seen on DOPPLER USG

7 WEEK

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The Head and Limbs are seen along with the amniotic cavity delineated by the Amnion.

10

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Week

Same as 7 week but the size increases indicating th growth. 10 week signals the end of the embryonic period

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CORPUS LUTEUM Increases in size producing progesterone if there is a pregnancy .If not, it involutes forming Corpus albicans. Increasing size of corpus luteum is normal and should be differentiated from Ectopic Ovarian Pregnancy

Corpus luteum may appear simple cyst, complex cyst,solid

COLOR DOPPLER

RING OF FIRE appearance

ABNORMAL PREGNANCY

SPONTANEOUS ABORTION Bleeding P/V

Distorted GS with no fetal pole and yolk sac.

Distorted GS with debris and membranes extending from the lower segment into cervix Arrow Thin decidual sign worrisome

FAILED PREGNANCY NORMAL Mean sac diameter (MSD) >8 MM should have yolk sac or else it is failed

pregnanacy /missed abortion.

> 16mm should have

fetal pole or embryo.If not it is failed pregnancy or abortion.

> 18 mm 5 mm fetal pole shd have cardiac activity. If not it indicates

fetal demise.

ECTOPIC PREGNANCY

Locations of ectopic pregnancy. (A) ampullary/isthmic, (B) infundibulum, (C) fimbria, (D) interstitial, (E) intraabdominal, (F) ovarian an(G) cervical.

PSEUDOGESTATIONAL

SAC Fluid filled cyst with a single layer of echogenic tissue lying in the endometrial canal

Adnexal Pregnancy

The mass might represent an early ectopic pregnancy before the appearance of the gestational sac, a failing ectopic pregnancy, a ruptured ectopic pregnancy surrounded by coagulated blood, or a corpus luteal cyst.

Adnexal ultrasound findings with a high positive predictive value (PPV) for ectopic pregnancy can be categorized into 4 groups: Live embryo in an extrauterine gestational sac (PPV = 100%, ),

adnexal mass with yolk sac or nonliving embryo (PPV close to 100%), complex or solid adnexal mass (PPV = 95%, Figure 12)

,and echogenic tubal ring/donut that is separate from the ovary (PPV = 90% to 95%, Figure 13)

Ovarian Pregnancy

Ring of vascularity on doppler

Tubal Pregnancy

Tubal ring sign seen in tubal pregnancy

normal

tubal ectopic

Separation of mass from ovary on pressure indicates ectopic pregnancy

FREE FLUID /BLOOD

Ruptured ectopic pregnancy

Free fluid in the hepato renal space in a symptomatic patient without intrauterine st pregnancy in 1 trimester is diagnostic of ruptured ectopic pregnancy

Free fluid in cul de sac -physiological free fluid in abdomen

INTERSTITIAL PREGNANCY

1.Empty uterine cavity 2. Eccentrically located GS surrounded by thin myometrial mantle

3.Interstitial line sign Cervical Pregnancy

doppler with peritrophoblastic blood flow

1.Empty Uterus 2.GS with closed internal os 3.GS with fetal pole and heart beat 4.Hour glass shaped uterus 5.Peritrophoblastic blood flow on doppler

Signs of spontaneous abortion 1.crenated GS 2.open internal os 3.Passage of GS over time 4.Sliding sign : The GS slides with the pressure with probe