Early pregnancy

A free gallery of high-resolution, ultrasound, color doppler and 3D images

Ultrasound images of early pregnancy:

1) Bicornuate uterus with gestation sac:

Pregnancy in one horn of uterus with two horns (cornu):

The above ultrasound images show a bicornuate uterus with a gestation sac in the right cornu (1). The empty left cornu (2) shows typical decidual changes of pregnancy. The 3rd image (bottom) is a sagittal section through each cornu.

Images courtesy of Dr. Ravi Kadasne, UAE.

2) Cornual pregnancy:

B mode 2D image : 3D image:

Sonography of the uterus shows a gestation sac of 6 weeks 4 days age, in the right cornu of the uterus. 3-D image of the uterus further confirms the findings. These ultrasound images are diagnostic of cornual pregnancy (a type of ectopic pregnancy). Ultrasound images courtesy of Dr. Latha Natrajan, Bangalore, India.

Reference: 1) http://www.thefetus.net/page.php?id=4 (free article)

2) http://www.jultrasoundmed.org/cgi/reprint/25/6/791.pdf (free article)

3) Another example of cornual or interstitial pregnancy:

Sonography of cornual pregnancy:

These ultrasound and color Doppler images show a gestation sac of 15mm. in the right cornu of the uterus (interstitial region of the fallopian tube). This patient had undergone IVF with embryo transfer 1.5 months back. The transvaginal Color / Power Doppler images (below) show a ring of vessels around the sac with a yolk sac (image lower right) within the gestation sac. No embryo is visualized at this stage. Note the empty endometrial cavity which shows decidual change. This pregnancy needs to be terminated with urgent surgical intervention.

Reference: http://www.medscape.com/viewarticle/557082_4

4) Sonography of ruptured ectopic (tubal) pregnancy with pelvic hemorrhage:

Sonography of the pelvis done on this female patient with pelvic pain and tenderness revealed: 1) enlarged (bulky) uterus with grossly thickened endometrium (decidual cast) of almost 15 mm. The uterus shows absence of any gestation sac. No pseudosac is seen. 2) Transvaginal scan of the pelvis shows a large collection of hemorrhagic fluid in the cul de sac 3) A right adnexal mass, presumably in the Right Fallopian tube is also seen. A left ovarian hemorrhagic cyst is also present.

These ultrasound images suggest a right tubal gestation with hematosalpinx with rupture of the Rt. Fallopian tube.

Ultrasound images courtesy of Dr. Gunjan Puri, Surat, India. The ultrasound machine used was the Toshiba Xario.

5) HETEROTOPIC GESTATION (also called Heterotopic pregnancy or simultaneous intrauterine and extrauterine pregnancy or coexistent intrauterine and extrauterine pregnancy):

(Transvaginal scan images):

TRANSABDOMINAL SCAN:

This patient presented with signs of early pregnancy with left sided pelvic pain and tenderness. Sonography of the pelvis shows an intrauterine pregnancy with a 6 weeks size embryo in the uterine cavity. There is also a coexistent left adnexal mass with a yolk sac like structure measuring 3 mm. and a possible embryo in the sac (6 weeks size). The right and left ovaries are separately identified on transvaginal ultrasound. These ultrasound images suggest heterotopic gestation (intrauterine embryo and a gestation sac in left adnexal region). Ultrasound images courtesy of Dr. Gunjan Puri, Surat, India. He used a Toshiba Xario ultrasound system here.

Reference: http://www.thefetus.net/page.php?id=3

6) Anembryonic gestation:

Sonography of early pregnancy in this case shows bulky (enlarged) gravid uterus showing a gestation sac of 13mm. (5 weeks, 1 day). The images show absence of the embryo. These ultrasound images suggest anembryonic gestation (usually known as missed abortion or blighted ovum). It is advisable to repeat the sonography (after 1 week to 10 days ), in such cases to rule out delayed development of the embryo. Other differential diagnoses include: inevitable abortion, incomplete abortion etc. One of the other causes of anembryonic gestation includes early demise of the embryo, leaving an empty sac.

Reference: http://emedicine.medscape.com/article/266228-diagnosis

7) Embryonic demise:

These ultrasound images show an intrauterine gestation sac with subchorionic hematoma (see transvaginal scan image in lower row), with an abnormally large yolk sac (7mm. size). This pregnancy is of 10 weeks gestational age (going by the date of last menstrual period). However the poorly developed embryo measures 6 mm. in size (6 weeks 2 days) and shows no cardiac activity which was confirmed by Power Doppler imaging. These ultrasound findings suggest embryonic demise. (Note: By current criteria, an embryo of more than 5 mm. in size showing no cardiac activity on transvaginal sonography, is considered to be non-viable/ case of embryonic demise).

Reference: http://emedicine.medscape.com/article/403208-imaging (free images and article)

8) Subchorionic hematoma:

This 1st trimester patient complained of pain in the lower abdomen. Sonography of the gravid uterus shows an anechoic collection (blood--> see arrows) in the upper part of the gestation sac between the decidual tissue and the chorion. There is also evidence of separation of the margins of the early placenta (abruption). The embryo, in this case, showed cardiac activity. These ultrasound images are diagnostic of subchorionic hematoma. It is advisable to follow this case with repeat sonography after 1 week and closely monitor the hematoma.

9) Abnormalities of yolk sac:

Large yolk sac:

This ultrasound image of early 1st trimester pregnancy shows a large yolk sac within the gestation sac in the uterine cavity. Both abnormally large or small yolk sacs are associated with poor prognosis and usually end in embryonic demise. No embryo was visualized in this case. A yolk sac diameter of greater than 5.6 mm. before 10 weeks gestational age indicates bad prognosis. In this case the yolk sac measured 10.6 mm. (This sonographic image is courtesy of Dr. Durr e Sabih, Pakistan).

Reference: http://www.jultrasoundmed.org/cgi/reprint/19/9/655.pdf (free article and images)

http://radiology.rsna.org/content/183/1/115.short (free article)

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This page was last edited on: Wednesday February 03, 2010 04:20 PM

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