Consultation with specialists should be obtained if an adnexal mass persists into the second trimester.The two most common benign neoplasms of the ovary during pregnancy are serous cystadenoma and benign cystic teratoma.In fact, certification of residency programs requires documentation of adequate exposure to and training in the evaluation of first-trimester ultrasound.Failure to understand the limitations of diagnostic ultrasound or inadequate training of physicians in this technique can result in grave complications for the patient and liability for health-care providers.The reader is referred to the American Institute of Ultrasound In Medicine for its extensive publications, workshops, and meetings (American Institute of Ultrasound In Medicine, 14570 Sweitzer Lane, Suite 100, Laurel, MD 20707–5906).described the orderly appearance of gestational sac, yolk sac, and embryo with heartbeat at a given number of days from the onset of the last menstrual period (Table 1).
For patients who are not at high risk for ectopic pregnancy, the two most common presenting symptoms are bleeding and pelvic pain. In a 1981 study, Kadar and associates found that a “discriminatory” β-h CG value of 6000 m IU/ml could be used as a cutoff for when an intrauterine gestational sac should be be seen via TAS.
5), and large subchorionic bleeds have all been associated with an increased risk of first-trimester pregnancy loss.
48 of 49 women determined to have an empty uterus via TVS were spared dilatation and curettage.
Considerable caution must be exercised not to confuse collections of fluid within a decidualized endometrium with early gestational sacs.
These “pseudogestational sacs” can lead to a missed diagnosis of ectopic pregnancy. Even in experienced hands, pseudosacs and early gestational sacs can be confused. An eccentrically placed intrauterine gestational sac 6 weeks postmenstruation ( arrow ). In contrast, a pseudosac ( arrow) in a patient with ectopic pregnancy representing a collection of blood or fluid collected within the endometrial cavity.
With a transvaginal probe, a 3- to 4-mm gestational sac can usually be seen by 5 weeks from the last menstrual period (Fig. A yolk sac or small fetal pole is usually seen by 6 menstrual weeks, when the mean diameter of the sac has reached 10 mm.