MIME-Version: 1.0 Content-Location: file:///C:/2B6B5EA9/PregFirstTri.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Emergency Sonography in Early Pregnancy

Emergency Sonography in Early Pregnancy<= /p>

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Scope of Practi= ce: (1.) to determine the presence or absence of= a definitive intrauterine pregnancy (IUP); (2.) to establish the presence or absence of fetal cardiac activity.

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Sonographic images= that support or negate the presence of IUP. Successful windows accomplish the following two goals: (1.) determine the presence or absence of an embryo or fetus (i.e. yolk sac, fetal pole or fetal cardiac activity), (2.) establish that the location of the image is located within the uterus and not in a location outside the uterus (i.e. adenexa). There are four windows for pelv= ic sonography – two four transabdominal sonography (TAS) and two for endovaginal ultrasonography (EVS) 

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  1. TAS for IUP– sagi= ttal window.  The transducer is superior to symphysis pubis, directed in an imaginary line through the umbilicus. = Landmarks: bladder, rectum, endometrial stripe, vesicouterine pouch, rectouterine pouch, cervix, vaginal canal.

 

Fi= gure 1A. TAS sagittal window visu= alizing the presence of an intrauterine gestational sac with yolk sac. The presence of the bladder anterior as well as the endometrial stripe supports= the fact that the location of sac is within the uterus.

 

Fi= gure 1B. TAS sagittal window visu= alizing the presence of an intrauterine gestational sac with fetal pole. The presence of the bladder anterior as well as the endometrial stripe supports= the fact that the location of sac is within the uterus.

 

Figure 1C. TAS sagittal window visualizing an empty uterus and free fluid in the rectouterine pouch.

 

 

  1. TAS for IUP – transverse view. From t= he TAS sagittal view, rotate the transducer 90 degrees counterclockwise or pl= ace it superior to symphysis pubis, directed in a line connecting the ante= rior superior iliac crests then fan the transducer in an inferior/superior direction. Landmarks: blad= der, rectum, vesicouterine pouch, rectouterine pouch, and ovaries.

 

 

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Fi= gure 2. TAS transverse window visualizing IUP. The presence of the bladder anterior supports the f= act that the sac is located within the uterus. Notice that ovaries can be visualized lateral to the uterus.

 

 

 

  1. EVS for IUP – sagittal view. The tran= sducer inserted in the vagina is directed toward the anterior fornix in a line through the umbilicus.  Landmarks: bladder, rectum, e= ndometrial stripe, vesicouterine pouch, rectouterine pouch, cervix, vaginal canal= .

 

 

Fi= gure 3A. EVS sagittal window demonstrating fetus. The presence of endometrial stripe supports the fact that the location of the sac within the uterus.

 

Fi= gure 3B. EVS sagittal window demonstrating gestational sac with double decidual sign. The presence of the bladder anterior as well as the endometrial stripe supports the fact that the location of sac is within the uterus.

 

 

  1. EVS for IUP – transverse view. From t= he sagittal EVS view, turn the transducer counterclockwise 90 degrees. Landmarks: bladder and ovarie= s.

 

Fi= gure 4. EVS transverse window demonstrating a fetus within the uterus= . The presence of the bladder anterior supports the fact that the location of= sac is within the uterus.