Early 20pregnancy 20problems by KQExAc

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									      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

								
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