Transcript Early pregnancy problems

The Pelvic Scan:
Early pregnancy problems
Gynaecological abnormalities
Normal pelvic anatomy
•
•
•
•
Anatomy of uterus and ovaries
Arterial blood supply
Venous blood supply
Neural supply
Gynaecological scan indications
•
•
•
•
•
•
•
Pelvic pain
Pelvic mass
Irregular/ heavy vaginal bleeding
Post menopausal vaginal bleeding
Infertility
Endocrine symptoms/ signs
Recurrent miscarriage
Routine
• Sagittal image uterus and bladder
– Length of endometrium and cervix
– Measure length uterus +/- ET in AP
– Check for fluid in POD
• Transverse image bladder and cervix
• Transverse image bladder and uterus at widest
part
– Image whole uterus as move cephalad
– Measure ET in AP
– Measure uterus width and AP
• Transverse to top of uterus
Routine
• Transverse image broad ligament
• Move to Right/Left
– Check no tubal dilatation
– Visualise ovary
– Move caudally if unable to see
• Split screen and measure ovarian volume
• Cyst?
– Measure volume
– Septations, papillary lesions, solid areas, low level
internal echoes
– Check mobility with valsalva or hand on abdomen
– Check for ascites
– Torsion?
TV Sagittal uterus
Early proliferative cycle
TV Sagittal uterus
Late proliferative cycle
TV Sagittal uterus
Secretory cycle
Endometrial thickness
TV Transverse uterus
Normal Ovary
Subserosal Fibroid
Subserosal Fibroid
Adenomyosis
Corpus luteum
Complex ovarian cyst
Complex ovarian cyst
Early pregnancy scan indications
•
•
•
•
Dating
Bleeding
Pain
Previous ectopic/ miscarriage/ molar
pregnancy
Complete miscarriage
Bleeding and
cramps
which are
usually
settling
Missed miscarriage
Spotting only
usually.
Expected to
be 6-12
weeks by
LMP.
Fetal pole
seen
Missed Miscarriage
Other miscarriages
• Anembryonic pregnancy
– Spotting or nil
– Gestational sac, MSD >2cm
– No fetal pole
• Incomplete miscarriage
– Bleeding and cramps
– RPOC
– Doppler to diagnose
• Threatened miscarriage
– Bleeding +/- pain
– Viable pregnancy
Ectopic pregnancy
• Pregnancy outside the uterine corpus
–
–
–
–
Ampulla
Cornu
Ovary
Abdominal
• Life- threatening intra-abdominal bleeding
• Symptoms and signs
– Spotting, pain- usually one side, fainting, shouler-tip
pain
• URGENT referral on USS diagnosis
• High index of suspicion if
– previous ectopic
– IUD
– infertility
Tubal Ectopic Pregnancy
USS findings
• Empty uterus
• Adnexal mass
– +/- FHR
– Ring of blood flow on doppler
– Tenderness on probe pressure over mass
• Free fluid especially POD
• TV scan ideally if available
Ectopic with FHR
Hydatidiform molar pregnancy
•
•
•
•
Abnormal placental development
Usually no recognisable fetus
‘Snowstorm’ appearance on USS
Exaggerated symptoms of pregnancy
– Hyperemesis
– Thyroid hormone abnormality
– Large theca-lutein cysts
• Rx is ERPOC and CXR
• Can recur and rarely in malignant form