Author: Sanja Kupesic. M.D., Ph.D

Sveti Duh General Hospital, University of Zagreb, Croatia

Authored date:2006-09-04

Patient History

A 28-year-old female presents at the ER with bleeding and abdominal pain and cramping symptoms that started four hours previously. Initially the patient thought that she was menstruating after not having done so for over two months.

Temperature, pressure and pulse measurements are within normal limits. The abdomen is soft, with minimal lower-quadrant tenderness and no rebound or guarding. Pelvic examination reveals blood in the vaginal vault and a closed cervix. Palpation reveals neither cervical motion tenderness nor adnexal masses. Uterus size is found to be consistent with six weeks gestation, and a urine pregnancy test yields a positive result. Based on clinical symptoms and findings, threatened abortion is suggested, although ectopic pregnancy must also be ruled out.

With first-trimester bleeding occurring in 20-30% of all pregnancies, and blighted ovum causing about 50% of first-trimester miscarriages, an ultrasound evaluation, including 3D and 4D imaging is suggested.

Clinical Images

3D Autosweep provides a high-resolution 3D volume in sagittal view, demonstrating a flattened gestational sac without embryonic echo or yolk sac.

4D real-time imaging in the coronal view demonstrates round-shape gestational sac with some peri-implantational bleeding in close proximity.

Clinical Outcome

Clinical picture is consistent with threatened abortion. Ultrasound virtually excluded the diagnosis of ectopic pregnancy. 3D/4D ultrasound clearly outlined an intrauterine gestational sac, although without visualization of an embryo within, a diagnosis of blighted ovum is suggested. Signs of peri-implantational bleeding are observed, explaining the symptoms of bleeding and pain. Since most cases presenting with early pregnancy bleeding are thought to be due to implantation bleed, no immediate treatment, such as D & C is recommended. Bed rest and continued clinical and ultrasound monitoring are advised. There is a minute chance that a subsequent ultrasound scan in seven days will visualize a yolk sac and embryonic echo.

Ultrasound Solution

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 Early Pregnancy Evaluation with 3D and 4D Ultrasound[1.15 MB]