Ultrasound signs of pathology in the first trimester of pregnancy

Non-developing pregnancy

A non-developing pregnancy often occurs with anembrionia and occurs quite often. At ultrasound examination the fetal egg has smaller sizes, than it is necessary on prospective gestational age, the embryo is not visualized.

If the clinically early pregnancy is normal, and if only the enlarged uterus is detected in the echography, anembrion may be suspected: repeat the test after 7 days. If the pregnancy is normal, the fetal egg will grow, the embryo will be clearly visualized, its heartbeat will be recorded.

Non-developing pregnancy (spontaneous abortion)

After the death of the fetus or embryo, the patient may feel pregnant for some time. Anamnesticheski can be determined bleeding and pain in the abdomen of a spastic nature. The uterus can be of normal size, can be reduced, it can even be increased if there is a hematoma in the uterine cavity. The embryo can be visualized, but the heartbeat will be absent. If the study is conducted at the time of 8 weeks of pregnancy, then it is necessary to conduct a second study after 7 days. After the 8th week with normal pregnancy, the fetal life must be determined necessarily.

After the 8th week of pregnancy, the fetal heart rate should always be determined

Uterus after miscarriage

If the patient had a miscarriage shortly before the test after the delay in menstruation (bleeding is sometimes determined by the fetus), then during the ultrasound study the uterus will be increased in accordance with the term of pregnancy. The uterus cavity will be empty.

Incomplete abortion

In the patient's anamnesis, a delay in menstruation with subsequent bleeding is determined, and the patients can see the fetus. The uterus will be increased in accordance with the term of pregnancy. The uterus can be empty, and the uterine cavity unexposed. In case of incomplete abortion, the uterus will be smaller than it is supposed to be by the term of pregnancy, a deformed fetal egg or amorphous masses of various sizes, shapes and echogenicity can be determined in the cavity. It can be pieces of the placenta, blood clots. The signs of the life of the fetus will not be determined.

After a miscarriage it is difficult to determine the presence of a former pregnancy. The diagnosis is established only in the presence of exact signs of the former pregnancy, for example a yolk sac, a fetal egg, a dead embryo. Thickening of the endometrium is an insufficient sign for the diagnosis of abortion, and it is also necessary to exclude vesicular drift.

Be careful: the gestational age, established by the patient herself, can not always be exact.

Enlarged uterus

The most common causes of uterine enlargement are:

• bladder skidding;
• choriocarcinoma;
• uterine bleeding against a background of spontaneous abortion:
• myoma of the uterus (fibroma).

Bubble skidding. Clinical data are nonspecific. The echographic picture has always been changed, with an enlarged uterus showing a sufficiently uniform echoesignal distribution, a patchy echostructure that creates the effect of a "snow storm". It may be difficult to distinguish bladder drift from hyperechoic blood in the uterine cavity, but the blood is usually more heterogeneous in structure and has a lower echogenicity than the bladder skeleton, in which cystic structures (vesicles) are defined. In patients of the older group, large fibroids can simulate a bladder drift, but with a bubble drift, more pronounced dorsal reinforcement and central necrosis zones will be detected. It is very important to remember that the fetus can still be present, while only part of the placenta will be affected. An embryo in combination with a bladder drift has a very high risk of developing chromosomal aberrations.

Choriocarcinoma can be indistinguishable from a vesicular drift during echography. This pathology can be suspected if there is a much larger uterine enlargement than is expected by the time of pregnancy. And when echography is determined more pronounced zones of hemorrhage and necrosis than with a bubble drift, which is characterized by the presence of monomorphic cystic structures. The echostructure of the choriocarcinoma is heterogeneous, with alternating solid and cystic components: with a bubble drift, the ehostruktura is more homogeneous, characterized by the effect of a "snow storm". Less common is the metastasis of choriocarcinoma: chest radiography is necessary to exclude metastases.

Bleeding due to medical or spontaneous abortion. This is mainly a clinical diagnosis, established in the presence of bleeding in the early stages of pregnancy: during echography, a different amount of blood can be detected in the uterus, which exfoliates the chorioamnotic and decidual envelope (the envelope that is part of the endometrium), visualized as an almost anechogenous zone. The blood can be completely anechogenous, maybe also hyperechoic. Usually the blood is represented by a heterogeneous structure. It is very important to determine the presence of signs of the fetus, since this will determine the tactics of conducting this patient. If there is any doubt, repeat the test at intervals of L or 2 weeks to determine a progressing pregnancy.

If there is any doubt, the test is repeated after 1 -2 weeks.

Enlarged, tuberous uterus. In the first trimester of pregnancy, an enlarged, tuberous uterus may occur in the presence of fibroids. Determine the size and position of the myomatous nodes so that you can foresee possible complications during labor. It is necessary to repeat the study in the presence of fibroids in terms of 32-36 weeks of pregnancy. Central zones of myoma can be necrotic, and a heterogeneous or anechoic structure in the center will be determined. This is not of significant clinical significance. Myoma can be simulated by thickening of the myometrium when the muscles of the uterus contract. In order to differentiate these states, you can repeat the test after 20-30 minutes and determine if the zone of thickening of the myometrium is changing. Uterine contractions are normal and change the inner contour of the uterus.