More detailed discussions of ultrasonography and its application in emergency medicine can be found in Chap 109. The earliest definitive sonographic finding in pregnancy is a gestational sac. Using transabdominal technique, the gestational sac can be detected at 5.5 to 6 weeks' gestation. With transvaginal technique, the gestational sac can be detected at 4 to 5 weeks' gestation. Other ultrasound markers of pregnancy and the gestational age at which they may be detected by transvaginal ultrasound include the yolk sac at 5 to 5.5 weeks' gestation, fetal pole at 5.5 to 6 weeks, and cardiac activity at 6 weeks. Correlation of these markers with specific, quantitative serum b-HCG values varies with the capabilities of the equipment and the skill of the ultrasonographer. 10 SPECIFIC ISSUES IN PREGNANCY Abdominal Discomfort
Many pregnant women experience abdominal discomfort. Round ligament tension and vascular congestion may cause lower abdominal discomfort from early in pregnancy. Braxton-Hicks contractions are irregular, palpable contractions that may occur throughout pregnancy. The differential diagnosis of abdominal pain varies with the stage of gestation and must include all the possibilities in a nonpregnant patient as well as those unique to pregnancy. Understanding of the physiologic changes of pregnancy avoids a delay in definitive diagnosis and management of pregnant patients with abdominal pain.
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