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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
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
TVS
TAS
4-5
gestational sac
Round shape, internal cystic echo
Two layers wall -
5
5-6
6-7
7-8
8-9
9-10
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
MULTIPLE PREGNANCY
T
sign
Lambda
sign
Failing Pregnancy/
Failure
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
Blighted
ovum
Transabdominal
ultrasound
Blighted
ovum
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
Cardiac abnormality
Prediction of TTTS (4 fold
increase in risk)
Acrania/Anencephaly
Holoprosencephaly
Encephalocele
Dandy-walker Syndrome
Univentricular heart
Gastrochisis
Exomphalos
Multidysplastic kidneys
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
Failure to visualize
intrauterine GS
consider
patient not
pregnant early
pregnancy
ectopic
pregnancy Use
beta hCG
Must see IUGS
with TVS if hCG
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
up to 13 6/7 weeks
gestation
Biparietal Diameter
Head
Circumference
Abdominal
Circumference
Femur Length
THANK
YOU