Week+6

First Trimester Complications

• Importance of confirming or excluding intrauterine pregnancy (IUP) if no yolk sac or embryo is seen.

Difficulties in Assessing Viability

• Distinction between viable and non-viable gestations is essential.

• Presence of a living embryo does not guarantee normal pregnancy outcomes.

Fetal Heart Rate Monitoring

• In addition to detecting fetal heartbeat:

  • Bradycardia: Heart rate below 90 beats per minute (bpm) may indicate imminent demise.

  • Tachycardia: Heart rate above 170 bpm may lead to heart failure.

Common Complications

• Vaginal Bleeding: A prevalent issue during the first trimester.

  • Types of bleeding include:

    • Implantation bleeding

    • Subchorionic hematoma

    • Retroplacental hematoma

    • Subamniotic bleeding

Implantation Bleeding

• Light vaginal bleeding caused by implantation of the fertilized ovum into the uterine wall.

Subchorionic Hemorrhage

• Occurs between the endometrium and gestational sac due to low-pressure bleeding from implantation.

• Large bleeds can lead to miscarriage or stillbirth; fetal activity is often a reassuring sign.

Sonographic Findings

• Early bleed appears echogenic; as time passes, it turns anechoic.

• Color flow Doppler shows the avascular nature of the hemorrhage.

Risks Associated with Subchorionic Hemorrhage

• Increases chances of miscarriage, stillbirth, placental abruption, and preterm labor.

• Risk of spontaneous abortion correlates with size of the hematoma.

Retroplacental and Subamniotic Hemorrhage

• Retroplacental Hematoma: Found behind the placenta; not commonly associated with vaginal bleeding.

• Subamniotic Hemorrhage: Located between the amnion and chorion; rare occurrence.

Summary of Hematomas

• Crescents of bleeding may indicate subchorionic hemorrhage.

• Most common is subchorionic, and rarest is subamniotic.

Patient Presentation for Subchorionic Hematoma

• Many patients asymptomatic; common symptoms include:

  • Vaginal bleeding

  • Abdominal pain

  • Threatened abortion.

Criteria for Pregnancy Failure

• Different measurements indicating suspicion of pregnancy failure:

  • CRL < 7 mm with no cardiac activity.

  • MSD of 16-24 mm without activity.

  • Absence of embryo adjacent to a yolk sac.

Empty Amnion Sign

• Indicates suspected failure based on the absence of an embryo with visible yolk sac.

Expanded Amnion Sign

• Suggests failure with an identifiable embryo but no heartbeat detected.

Findings Diagnostic of Pregnancy Failure

• CRL ≥ 7 mm without heartbeat.

• MSD ≥ 25 mm without embryo.

Blighted Ovum (Anembryonic Gestation)

• No fetal pole within gestational sac; often irregular gestational sac borders.

• Clinical findings include vaginal bleeding and pelvic pain.

Embryonic Demise

• Previously called fetal demise; results from embryo or fetus death without cardiac activity.

• Common signs are vaginal spotting, abdominal pain, and detectable irregularities in ultrasound imaging.