Should the Norwegian public prenatal care program include an ultrasound scan in the first trimester?
1st trimester scan
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Transcript of 1st trimester scan
![Page 1: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/1.jpg)
Basic ultrasound in O&G
![Page 2: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/2.jpg)
Why scan?
Pregnancy
Mass per abdomen
Screening procedure - Pap smear, abd scan
Liver/gallbladder
Kidney/ bladder
![Page 3: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/3.jpg)
Pregnancy scanning
Confirmation of pregnancy:
POA
UPT
Scan
![Page 4: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/4.jpg)
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???
![Page 5: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/5.jpg)
Pregnancy scanning
No. of fetuses/ sacs
Viability of fetuses:
Out of sync
Wrong dates
Missed abortion
Incomplete abortion
Molar pregnancy
![Page 6: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/6.jpg)
Pregnancy scanning
Ectopic pregnancy:
History
UPT
Complaints- symptoms
Signs- classical, silent, leaking
USS-by exclusion, vaginal probe, fluid in POD
![Page 7: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/7.jpg)
Pregnancy scanning
Abnormality scan:
1st trimester
2nd trimester
3rd trimester
Placenta:
Error in localisation
Probe
Wait > 34/52
![Page 8: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/8.jpg)
Pregnancy scanning
Sex
Growth scan:
BPD/AC/HC/wt
Liquor volume-AFI
Charts
![Page 9: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/9.jpg)
Pregnancy scanningAbnormal lie/ presentation:
Breech
Transverse
Unstable
Post-partum:
Hemorrhage/retained placenta
Sepsis
Uterus = 12/52 at 12/7
![Page 10: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/10.jpg)
Gynaecological scanning
Uterus: uterine fibroid, adenomyosis, polyp
Cervix: fibroid, polyp
Ovarian: cyst, mass
Infertility work up: vaginal probe
![Page 11: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/11.jpg)
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
![Page 12: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/12.jpg)
1st trimester u/s
Viability:
size and shape of GS
CRL
FH
![Page 13: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/13.jpg)
1st trimester u/s
No. of fetuses
Nuchal translucency
Dating of pregnancy
![Page 14: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/14.jpg)
Dating of pregnancy
Abdominal method:
Full bladder in early pregnancy:
Pushes uterus out of pelvis
Acoustic window
Displaces bowel superiorly
![Page 15: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/15.jpg)
Dating of pregnancy
Holding of probe (alignment):
Maternal bladder on the right
Fundus on the left
![Page 16: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/16.jpg)
![Page 17: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/17.jpg)
![Page 18: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/18.jpg)
Dating of pregnancyEmbryo 37 days
![Page 19: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/19.jpg)
Dating of pregnancy
Head discriminated against torso:
7w+3d
8 weeks:
Movements with limbs
![Page 20: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/20.jpg)
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
![Page 21: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/21.jpg)
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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
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![Page 24: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/24.jpg)
Dating of pregnancy
After 12w ++flexion --> delay after 15w
![Page 25: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/25.jpg)
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
![Page 26: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/26.jpg)
Nuchal translucency
Measurement
![Page 27: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/27.jpg)
Problems of early pregnancy
Miscarriage
Ectopic pregnancy
Abdominal pregnancy
Trophoblastic disease
Ovarian probs in early pregnancy
Uterine fibroids
Pregnancy with IUCD
![Page 28: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/28.jpg)
Problems of early pregnancy
Hormonal measurement (HCG)
Monoclonal antibody based UPT can detect >25 iu/L = 24-25/7 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
![Page 29: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/29.jpg)
Miscarriage
20% incidence
Threatened
Missed
Complete
Incomplete
![Page 30: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/30.jpg)
Problems of early pregnancy
Threatened miscarriage :
PV bleed with live embryo
15% proceed to miscarriage
Subchorionic haematoma # poor outcome
![Page 31: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/31.jpg)
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
![Page 32: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/32.jpg)
Missed miscarriage
![Page 33: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/33.jpg)
Problems of early pregnancy
Complete miscarriage:
Thin endometrium
Same as non pregnant uterus
![Page 34: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/34.jpg)
Complete miscarriage
![Page 35: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/35.jpg)
Problems of early pregnancy
Incomplete miscarriage:
Endometrial thickness between 5-15mm
Combine diagnosis with clinical situation e.g VE
![Page 36: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/36.jpg)
Incomplete miscarriage
![Page 37: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/37.jpg)
Problems of early pregnancy
Ectopic pregnancy:
Implantation outside uterine cavity:93% tubal
Incidence around 1%
Presentation: classical, abd pain with PV bleeding, silent
![Page 38: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/38.jpg)
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
![Page 39: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/39.jpg)
Problems of early pregnancy
Trophoblastic disease:
Spectrum: benign- hydatidifom mole, malignant- choriocarcinoma
Complete hydatidifom mole- snow storm appearance, no fetal tissue, serum HCG high
Partial hydatidifom mole- trophoblastic hyperplasia w fetal tissue
![Page 40: 1st trimester scan](https://reader030.fdocuments.net/reader030/viewer/2022012400/554aed70b4c905852a8b5458/html5/thumbnails/40.jpg)
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