Ultrasound Findings

The first sonographic finding in early pregnancy is the gestational sac. This is a hypoechoic structure that is slightly eccentric in its location within the uterine cavity. The decidua capsularis and decidua vera are seen as two distinct hypoechoic layers surrounding the early gestational sac; this is known as the double decidual sac sign (Fig 109-8). The yolk sac is the next embryonic structure to be visualized. It appears as a small ringlike structure within the gestational sac. Finally, the fetal pole can be recognized adjacent to the yolk sac (Fig 109-9).6 Cardiac activity can usually be observed if a fetal pole is present. The normal fetal heart rate seen in early pregnancy is 112 to 136 beats per minute, slower than heart rates observed in the second and third trimesters. If the ovaries are imaged early in pregnancy, a corpus luteum cyst may be seen (Fig 109-9). These cysts usually measure 2 to 4 cm in diameter (can be up to 10 cm) with 3 to 4 mm walls. Corpus luteum cysts are generally anechoic; however, if they are hemorrhagic, they will contain internal echoes.

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FIG. 109-8. Early intrauterine pregnancy. A gestational sac with a clear double decidual sign ( arrow) between the two decidual layers on a transvaginal image in the

sagittal plane.

sagittal plane.

Corpus Luteum Double

FIG. 109-9. Early intrauterine pregnancy. The ovary with a corpus luteum cyst is seen adjacent to the uterus. A yolk sac and fetal pole are present within the gestational sac.

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