ultrasound assessment of early pregnancy. from to the only period of gestation not detected directly
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Ultrasound Assessment Ultrasound Assessment of of
Early PregnancyEarly Pregnancy
fromfrom
toto
THE ONLY PERIOD OF THE ONLY PERIOD OF GESTATION NOT DETECTED GESTATION NOT DETECTED
DIRECTLY DIRECTLY
First Week of DevelopmentFirst Week of DevelopmentOvulation to ImplantationOvulation to Implantation(not visible by ultrasound)(not visible by ultrasound) Fertilization occurs at the ampullary region of Fertilization occurs at the ampullary region of the fallopian tube.the fallopian tube. The diploid number of chromosomes are The diploid number of chromosomes are restored.restored. Chromosomal sex is determined.Chromosomal sex is determined. In the fifth day, the blastocyst is embedded in In the fifth day, the blastocyst is embedded in a well prepared, thick endometrium. a well prepared, thick endometrium.
UTERINE ARTERY
ARCUATE ARTERIES
RADIAL ARTERIES
LINEAR BRANCHES(basal art.)
ZONE BASALIS
CURVED BRANCHES(spiral art.)
ZONEFUNCTIONALIS
SECRETION PHASESECRETION PHASE THICKNESSTHICKNESS 7 - 16 mm 7 - 16 mm
homogen and hyperechogenic homogen and hyperechogenic echo as result of mucin and echo as result of mucin and glycogen in tortuotic glycogen in tortuotic endometrial glandsendometrial glands
TRIPPLE LINE ENDOMETRIUM
5 days post conception
BlastocystBlastocyst
Second week of DevelopmentSecond week of Developmentbilaminar Germ Diskbilaminar Germ Disk(not visible by ultrasound)(not visible by ultrasound)
The trophoblast differentiates into an inner The trophoblast differentiates into an inner cell mass (the cytotrophoblast) and an outer cell mass (the cytotrophoblast) and an outer cell mass (the syncytiotrophoblast), which cell mass (the syncytiotrophoblast), which erodes the endometrium.erodes the endometrium.
Lacunar network is formed by the end of the Lacunar network is formed by the end of the second week and a primitive utroplacental second week and a primitive utroplacental circulation begins. circulation begins.
Third week of DevelopmentThird week of Developmenttrilaminar germ disktrilaminar germ disk(not visible by ultrasound)(not visible by ultrasound) The most characteristic event is The most characteristic event is
gastrulation. gastrulation. By the end of the third week three basic By the end of the third week three basic
germ layers consisting of ectoderm, germ layers consisting of ectoderm, mesoderm, and endoderm are mesoderm, and endoderm are established.established.
Tissue and organ differentiation has Tissue and organ differentiation has begun. begun.
Uterine perfusion in early pregnancy
Third to Eighth Week of Third to Eighth Week of DevelopmentDevelopmentThe Embryonic Period The Embryonic Period
This is the period of organogenesis.This is the period of organogenesis. Each of the three germ layers (ectoderm, Each of the three germ layers (ectoderm,
mesoderm and endoderm) give rise to its mesoderm and endoderm) give rise to its own tissues and organ systems.own tissues and organ systems.
Major features of body form are Major features of body form are established.established.
Gestational Sac at 4 wksGestational Sac at 4 wks
Gestational Sac at 5 wksGestational Sac at 5 wks12-13 mm12-13 mm
Establishment of Establishment of intervillous circulationintervillous circulation
Lacunar formation – 10Lacunar formation – 10thth to 13 to 13thth days after days after conception conception
Filled with blood on day 15Filled with blood on day 15thth Tertiary Villi formation on day 20Tertiary Villi formation on day 20thth
Villous capillaries become connected with the Villous capillaries become connected with the embryonic heart tubeembryonic heart tube
- - TRANSFER OF TRANSFER OF NUTRIENTS NUTRIENTS IN THE IN THE
3rd AND 4th WEEK3rd AND 4th WEEK OF OF GESTATIONGESTATION
- - HAEMATOPOESIS IN THE HAEMATOPOESIS IN THE 5TH WEEK 5TH WEEK
- - THE INITIAL SITE OF THE INITIAL SITE OF PRODUCTION OF PRODUCTION OF AFP, AFP,
PREALBUMIN, ALBUMIN PREALBUMIN, ALBUMIN AND TRANSFERINAND TRANSFERIN
- - ALL FUNCTIONS ARE ALL FUNCTIONS ARE COMPLETEDCOMPLETED
BY BY 8 WEEKS8 WEEKS OF OF GESTATIONGESTATION
- - TRANSFER OF TRANSFER OF NUTRIENTS NUTRIENTS IN THE IN THE
3rd AND 4th WEEK3rd AND 4th WEEK OF OF GESTATIONGESTATION
- - HAEMATOPOESIS IN THE HAEMATOPOESIS IN THE 5TH WEEK 5TH WEEK
- - THE INITIAL SITE OF THE INITIAL SITE OF PRODUCTION OF PRODUCTION OF AFP, AFP,
PREALBUMIN, ALBUMIN PREALBUMIN, ALBUMIN AND TRANSFERINAND TRANSFERIN
- - ALL FUNCTIONS ARE ALL FUNCTIONS ARE COMPLETEDCOMPLETED
BY BY 8 WEEKS8 WEEKS OF OF GESTATIONGESTATION
THE ROLE OF YOLK SACTHE ROLE OF YOLK SACTHE ROLE OF YOLK SACTHE ROLE OF YOLK SAC
GESTATIONAL SAC DIAMETER › 8 mm
5-6 weeks:•Early trophoblast•Lacunar flow•Secondary yolk sac
the first visible structures withingestational sac
5 - 6 w.g.a.5 - 6 w.g.a.
INTERVILOUSINTERVILOUSSPACE ( IVS )SPACE ( IVS )
Embryo at 6 wksEmbryo at 6 wks
The embryo is 3-4 mm.
G.S is 14-15 mm
Heart activity visualized
INTERVILLOUSBLOOD FLOW
EMBRYO
ONSET OF HEARTONSET OF HEART A ACTIVITYCTIVITY
UMBILICALCORD
FETALAORTA
FETALHEART
LIMB BUDS
GROSS BODY MOVEMENTS
THE HEAD IS MORE PROMINENT DUE TO THE DEVELOPING RHOMBENCEPHALON. NO EVIDENCE OF CEREBRAL CIRCULATION.
Embryo at 7 wksEmbryo at 7 wks
Chorionic cavity 19-20 mm Embryo 5-6 mm
GROSS BODY MOVEMENTS
ARMS AND LEGSMOVEMENTS
CEREBRALVESSELS
FETALAORTA
Cerebral circulation started
Embryo at 8 wksEmbryo at 8 wks
Amniotic Cavity 17-19 mm.
Choroinic cavity 30-32 mm.
Embryo size is 16-18 mm.
Third month to birth Third month to birth the Fetus and Placenta the Fetus and Placenta
The fetal period extends from the ninth The fetal period extends from the ninth week of gestation until birth and it is week of gestation until birth and it is characterized by rapid growth of the body characterized by rapid growth of the body and maturation of organ systems.and maturation of organ systems.
CEREBRALVESSELS
HEART
FETALAORTA
Cerebral circulation is established
STARTLE
GROSS BODY MOVEMENTS
ARMS AND LEGSMOVEMENTS
STRECTHING
HEAD ROTATION
HAND MOVEMENTS
Fetus at 9 wks with clear amniotic Fetus at 9 wks with clear amniotic membranemembrane
Embryo is 24-31 mm
Fetus at 10 wksFetus at 10 wks
Beginning of Ossification
Falx cerebri appears
Choroid plexus occupy the ventricles
Abdomen shows physiological omphalocele
3D Fetus at 10 wks3D Fetus at 10 wks
ALL THREE SEGMENTS OF THE UPPER AND LOWER EXTREMITIES ARE VISIBLE
Fetus at 10 wks showing facial Fetus at 10 wks showing facial detaildetail
The neck is visualized which in a sagital section presents the nuckal area – a double hyper echogenic outline – septated by a millimetric hypo echogenic band corresponding to subcut. tissue.
• GENERAL MOVEMENTS
• STARTLE
• STRETCHING
• ISOLATED ARM MOVEMENTS
• ISOLATED LEG MOVEMENTS
• HEAD MOVEMENTS AND
ROTATIONS
• HAND TO FACE CONTACT
Head rotationLimb movementsGeneral movements
Clench and unclench fists
Fetus at 12 wks – arm/fingers Fetus at 12 wks – arm/fingers visiblevisible
The fetus is much more explorable
• GENERAL MOVEMENTS
• STARTLE
• STRETCHING
• ISOLATED ARM MOVEMENTS
• ISOLATED LEG MOVEMENTS
• HEAD MOVEMENTS AND
ROTATIONS
• HAND-FACE CONTACTS
LAMBDA SIGN
BICHORIONIC BIAMNIOTIC TWINSBICHORIONIC BIAMNIOTIC TWINS
FRONTFRONT BACKBACK
STRUCTURESSTRUCTURES 33 44 55 66 77 88 99 1010 1111 1212
Gestational sacGestational sac
Yolk sacYolk sac
EmbryoEmbryo
Heart ActivityHeart Activity
Brain VesicleBrain Vesicle
Neural tubeNeural tube
Fourth VentricleFourth Ventricle
LimbLimb
Phisiological Umbilical Phisiological Umbilical HerniaHernia
Lateral VentricleLateral Ventricle
Choroid PlexusChoroid Plexus
Falx CerebriFalx Cerebri
NeckNeck
StomackStomack
CerebelumCerebelum
KidneyKidney
GESTATIONAL WEEKSGESTATIONAL WEEKS
THANKTHANK
YOUYOU
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