8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 1/44

NORMAL &ABNORMAL

INTRAUTERINE

PREGNANCY

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 2/44

FIRSTTRIMESTER

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 3/44

4th WEEK

INTRADECIDUAL SACSIGN (IDSS)

Intrauterine anechoic cyst seen @ 4 –5 weeks on TVS.Indicates

1. Normal Pregnancy2. Decidual Cyst3. Pseudogestational sac

Not definitive for pregnancy

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 4/44

Anechoic sac with asurrounding hyperechoic

ring of decidual sac –

IDSS

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 5/44

DOUBLE DECIDUAL SACSIGN

Black circle GS ,displacingthe Uterine

endometrium.White area

thickened decidual tissue

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 6/44

Double decidual sac sign

formed by DeciduaCapsularis and DeciduaParietalis with fluid in

endometrial cavity seen asan hypoechoic lineseparating the two

hyperechoic decidual

layers

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 7/44

DDS – White arrow -

hyperechoic decidualreaction,DeciduaCapsularis

Black arrow – uterineendometrial lining,Decidua

Vera/parietalisThe two hyperechoic lines

indicate DDSS

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 8/44

NEGATIVE IDSS

Gestational sacsurrounded by

uterine endometrium

Indicates : Abortion

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 9/44

Lower Uterine Segmentgestational sac

Hour glass uterus can beseen

Indicates 1. CervicalPregnancy

2.Passing Abortion

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 10/44

DOPPLER

Normal Marked vascularity

on Colour Doppler at thesite of Implantation

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 11/44

Other characteristics of anormal intrauterinegestational sac include:1.Continuous echogenic

rim of at least 2 mmthickness,

2.spherical or ovoid shape,

3.location in the upper or middle portion of the

uterus, and

4.growth >1.2 mm per day.

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 12/44

5th WEEK

Gestational sac with Yolk

sac – Definite Indicator of Intrauterine Pregnancy

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 13/44

6th WEEK

The Fetal Pole is seenalong with Yolk Sac inside

the Gestational Age.

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 14/44

Cardiac activity seen onDOPPLER USG

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 15/44

7

th

WEEK

The Head and Limbs areseen along with the

amniotic cavity delineatedby the Amnion.

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 16/44

10th Week

Same as 7th week but thesize increases indicating

growth. 10th week signalsthe end of the embryonic

period

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 17/44

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 andshould be differentiatedfrom Ectopic Ovarian

Pregnancy

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 18/44

Corpus luteum mayappear simple cyst,complex cyst,solid

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 19/44

  COLOR DOPPLER

RING OF FIREappearance

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 20/44

ABNORMALPREGNANCY

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 21/44

SPONTANEOUSABORTION

Bleeding P/V

Distorted GS with no fetalpole and yolk sac.

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 22/44

Distorted GS with debrisand membranes extending

from the lower segment

into cervixArrow – Thin decidual sign

worrisome

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 23/44

FAILED PREGNANCY

NORMALMean sac diameter (MSD)>8 MM should have yolk

sac or else it is failed

pregnanacy /missedabortion.

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 24/44

> 16mm – should have

fetal pole or embryo.If notit is failed pregnancy or 

abortion.

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 25/44

> 18 mm – 5 mm fetal poleshd have cardiac activity.If not it indicates

fetal demise.

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 26/44

ECTOPIC PREGNANCY

Locations of ectopicpregnancy. (A)

ampullary/isthmic, (B)infundibulum, (C) fimbria, (D)

interstitial, (E) intra-abdominal, (F) ovarian an(G)

cervical.

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 27/44

PSEUDOGESTATIONAL

SAC

Fluid filled cyst with asingle layer of echogenic

tissue lying in theendometrial canal

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 28/44

Adnexal Pregnancy

 

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 29/44

The mass might representan early ectopic pregnancy

before the appearance of the gestational sac, a

failing ectopic pregnancy, a

ruptured ectopicpregnancy surrounded by

coagulated blood, or a

corpus luteal cyst.

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 30/44

Adnexal ultrasound

findings with a highpositive predictive value(PPV) for ectopicpregnancy can be

categorized into 4 groups:Live embryo in an

extrauterine gestational

sac (PPV = 100%, ),

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 31/44

adnexal mass with yolk

sac or nonliving embryo(PPV close to 100%),complex or solid adnexalmass (PPV = 95%, Figure

12)

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 32/44

,and echogenic tubalring/donut that is separatefrom the ovary (PPV =

90% to 95%, Figure 13)

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 33/44

Ovarian Pregnancy

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 34/44

Ring of vascularity ondoppler 

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 35/44

Tubal Pregnancy

Tubal ring sign seen intubal pregnancy

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 36/44

normal tubal ectopic

Separation of mass from

ovary on pressureindicates ectopicpregnancy

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 37/44

FREE FLUID /BLOOD

Ruptured ectopic

pregnancy

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 38/44

Free fluid in the hepato

renal space in asymptomatic patientwithout intrauterine

pregnancy in 1st trimester is diagnostic of ruptured

ectopic pregnancy

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 39/44

Free fluid in cul de sac-physiological free fluid in

abdomen

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 40/44

INTERSTITIALPREGNANCY

1.Empty uterine cavity2. Eccentrically locatedGS surrounded by thin

myometrial mantle

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 41/44

3.Interstitial line sign

Cervical Pregnancy

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 42/44

doppler withperitrophoblastic blood

flow

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 43/44

1.Empty Uterus2.GS with closed internal

os3.GS with fetal pole and

heart beat

4.Hour glass shapeduterus

5.Peritrophoblastic blood

flow on doppler 

8/3/2019 Usg Normal Pregnanacy

http://slidepdf.com/reader/full/usg-normal-pregnanacy 44/44

Signs of spontaneousabortion

1.crenated GS2.open internal os

3.Passage of GS over time

4.Sliding sign : The GSslides with the pressure

with probe