Pregnancy US

Abnormalities in maternal serum marker levels and fetal measurements obtained during the first trimester screening can be a marker not only for certain chromosomal disorders and anomalies in the fetus but also for specific pregnancy complications. In particular, low maternal serum pregnancy-associated plasma protein-A (PAPP-A), at 11–13 weeks of gestation, is associated with stillbirth, infant death, intrauterine growth restriction, preterm birth, and pre-eclampsia in chromosomally normal fetuses, while a raised nuchal translucency is associated with specific structural abnormalities and genetic syndromes. We have studied the serum Papp-A level in 560 pregnant patients (11–13 weeks gestation) registered at Bharati Hospital and Research Centre, Pune. All patients undergoing testing were followed till the delivery and their neonatal outcome was also taken into consideration.

Aims and Objectives

Our aim is to study the pregnancy outcome in relation to the variations of Papp-A level in the first trimester of pregnancy.

Materials and Methods

Every patient visiting the antenatal OPD was counseled for testing of First Trimester Screening to assess fetal well-being. Patients who were registered for delivery at our hospital were taken into the trial. Blood samples were taken at 11–13 weeks of pregnancy and sent to the PerkinElmer lab for analysis. Results were expressed in Multiple of Median and patients having MOM value less than 0.5 were carefully observed till the delivery, and a thorough neonatal examination was done by a pediatrician.
Though Papp-A level in the first trimester of pregnancy (11–13 weeks) is an important predictor of future obstetric outcome, it has poor positive predictive value. Patients having a Papp-A level less than 0.5 MOM have a high risk for preterm delivery, fetal growth restriction, and stillbirths along with increased incidence of hypertensive disorders of pregnancy. A low Papp-A level is a useful indicator of risk of preterm delivery and future chance of development of pregnancy-induced hypertension.
Keywords: Papp-A in pregnancy, Preterm delivery, Fetal growth restriction
A low PAPP-A is defined as a maternal serum PAPP-A value <0.4 MOM, with increased frequency of adverse obstetrical outcomes noted below this level
PAPP-A is a large glycoprotein produced by the placenta and decidua thought to have several functions, including prevention of recognition of the fetus by the maternal immune system, matrix mineralization, and angiogenesis. A low PAPP-A is therefore descriptive of poor early placentation resulting in complications such as fetal growth restriction, fetal demise, preterm birth, and pre-eclampsia in the third trimester.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984652/

In fact, the most common reason doctors order ultrasounds before the 12- or 13-week point is to accurately date your pregnancy.
f your pregnancy symptoms don’t match up with your last menstrual period or there’s any confusion about how old your baby is — gestationally speaking — the measurements taken during an early ultrasound can tell your doctor exactly how far along you are in your pregnancy.
Other reasons for an early ultrasound include:

• Confirming twins or multiples. Especially if you’ve had fertility treatments, this might be something you want to confirm ASAP (as soon as possible).
  
• Confirming fetal heartbeat. If you’ve had any concerning symptoms, like spotting or vaginal bleeding, your doctor will want to know if you’re experiencing a miscarriage or what the cause of any unexplained bleeding could be.
  
• Ruling out an ectopic pregnancy. When an embryo implants outside the uterus, you’ll often have pregnancy symptoms and a positive pregnancy test, even though the embryo isn’t viable. An ectopic pregnancy is a life threatening condition if it’s not treated, so it’s important to diagnose it.
  
• Checking your reproductive anatomy. Issues with your uterus, cervix, ovaries, or fallopian tubes can cause complications during pregnancy. So, if your doctor suspects you might have a problem — like uterine fibroids, for example — they may want to have that info right away.
  
• the embryo is simply too tiny for clear images to be detected. You may see the general shape of your baby or be able to tell something is there, but it’s also normal to not see anything that looks very much like a baby at all.
  
• One thing you will often see in a healthy pregnancy is your baby’s heartbeat. It could be going as fast as 110 beats per minute or more! If your baby is in a visible position on the ultrasound, you’ll probably see a little blinking or pulsing on the screen (and you should be able to hear it briefly, too).
  

ou may see the following anatomical developments on a 7-week ultrasound:

• Gestational sac. This is one of the earliest visible signs of a pregnancy, and it refers to the fluid-filled space surrounding the embryo. It’s usually formed by 5 weeks of gestation, and it can accurately confirm an intrauterine pregnancy the vast majority of the time it’s seen on an ultrasound. It will look like a clear, dark circular or oblong shape, sharply contrasted with the whitish, opaque appearance of the inside of your uterus.
  
• Yolk sac. Even before you can see an embryo inside the gestational sac, you should spot the yolk sac. It’s the first thing to develop inside the gestational sac, and it provides your baby with nutrients and oxygen until the placenta develops. It’ll look like a small white ring or bubble inside the sac.
  
• Fetal pole. This is the first indication that your baby is forming inside the gestational sac. It will look like a thick, whitish shape attached to the yolk sac. Depending on how far along you are, it may be curved or oblong. It can usually be detected by 6 weeks of gestation on a transvaginal ultrasound. This is where you would see the baby’s heartbeat.
  

• What measurements will be taken (and why) 

  
  Aside from detecting a heartbeat, the point of a 7-week ultrasound is to take measurements of these fetal developments so your doctor has a better idea of where you are in your pregnancy.
  That’s why this is often called a dating ultrasound: The measurements are a good indicator of gestational age.
  The technician will measure the size of your gestational sac and also take a crown-to-rump measurement of the embryo, if it’s visible. At 7 weeks, your baby should be about 5 to 9 millimeters (mm) in size and the gestational sac will be about 18 to 24 mm.
  At this point, fetal development is on a fast track and making large leaps in size from one week to the next.
  A gestational sac measuring well below 18 mm will probably reduce your gestational age — that is, your doctor might tell you you’re only 5 or 6 weeks pregnant, not 7. The opposite is true for a sac that measures much larger than 24 mm.
  Keep in mind that ultrasounds aren’t a perfect diagnostic tool, and things like the position of your baby can affect the accuracy of the measurements — or whether your technician is able to take them at all.
  If the results are inconclusive, your doctor may ask you to schedule another ultrasound in 1 or 2 weeks to try again.
  

IF there are no signs of pregnancy or inconsistent signs, like a large gestational sac without any yolk sac or fetal pole, it may mean you have a blighted ovum or are otherwise miscarrying. This is very common in the earliest weeks of pregnancy, when the risk is the highest.
If you’re still experiencing early pregnancy symptoms but no fetal growth at all can be found in your uterus, your technician will probably look for signs of an ectopic pregnancy. This may be done along with blood tests and a pelvic exam.

Are twins visible this early? 

Yes, especially if they’re fraternal. Figuring out how many babies are growing in your uterus is one of the main reasons for having an early ultrasound.
If your twins are fraternal — meaning, two different eggs were fertilized — there will be a separate gestational sac for each baby. If you’re estimating your pregnancy accurately, multiple sacs should be pretty visible on a transvaginal ultrasound at 7 weeks.
If your twins are identical — meaning, one egg was fertilized but then split in two — there’ll only be one gestational sac; however, more than one yolk sac, fetal pole, and heartbeat may be visible.
Again, keep in mind that ultrasounds aren’t foolproof. You may not be far enough along in your pregnancy for all these things to be detected.
And remember that babies like to hide, especially when they have a sibling to hide behind! Multiple gestational sacs may not be visible until a later ultrasound.

8th-week
Heart Beat

While the fetus is still very small at this stage, the 8-week ultrasound can confirm a heartbeat.

In the early days of pregnancy, those initial appointments can feel surreal (unreal)— especially if this is your first pregnancy. Those first appointments are usually designed to get a baseline understanding of your health going into pregnancy and to make sure things are progressing properly.

One major milestone (a significant event in yr life) is the 8-week ultrasound. So, why do you have an ultrasound this early into pregnancy, and what can you expect at your 8-week ultrasound? We’ll answer those questions and more.

What happens during the ultrasound at 8 weeks?

Even though you can get a positive pregnancy test result roughly 2 weeks after conception, it can be a while until that tiny ball of cells demonstrates physical changes that confirm your pregnancy is progressing. Specifically, a healthcare professional will want to confirm that your fetus has a heartbeat — a clear sign that they’re alive.
In some cases, a heartbeat may be detected as early as 6 weeks. When you have a positive pregnancy test, contact a physician or healthcare professional to see if you need to come in for an ultrasound.

• Using a transvaginal approach the fetal heart beat nay be seen flickering before the fetal pole is even identified or measurable.
  
• It will be seen alongside the yolk sac.
  
• It may be below 100 beats per minute but this will increase to between 120- 180 beats per minute by 7 weeks.
  
• In the early scans at 5-6 weeks just visualising a heart beating is the important thing. Failure to identify fetal cardiac activity in a fetus whose overall length is greater than 4 mm is an ominous sign.
  

Sometimes there is difficulty distinguishing between the maternal pulse and fetal heart beat. Often sonographers will take the mothers pulse or doppler a maternal artery at the same time to check if it is the fetus or the mothers .



Cardiac activity is visualised using M mode during a transvaginal scan.
beyond heartbeat, the technician or physician will be able to immediately identify key features such as the gestational sac (GS) and your fetus’s crown-rump length (CRL). These can help determine gestational age (GA) and pinpoint your due date.
For now, you’ll see a little figure that looks something like an oblong bean. If there are twins, you might see two figures. The head is still nearly the same size as the rest of the body.
You’ll also see the gestational sac, the fluid-filled space around your baby(s). Within it, you can also see the yolk sac, which is a bubble-like structure. Depending on the location, you might even get to hear their heartbeat, too.
The main reasons for the 8-week ultrasound may be 1/ to confirm a pregnancy 2/ determine a due date, and 3/ confirm the baby’s heartbeat. First, your doctor or technician will look for key physical indicators, like a gestational sac and a fetal pole, to verify the pregnancy is in the uterus. This is may be your first indication of diagnosing twins.
The accepted method for early pregnancy dating is the crown-rump length (CRL) measurement because it’s the most accurate (within about 5 to 7 days) in the first trimester.
https://www.healthline.com/health/pregnancy/8-week-ultrasound?utm_source=ReadNext#medical-assessment

To measure fetal heart rate with M mode
(1)
1. Take a nice sonogram of fetal heart
2. Sekect M mode from mode settings
3. Place the straight dotted over the moving structure e.g valves.
4. Watch the M mode to see the tracing
5. Freez & go to measurement icon & select : fetal heart
6. Measure one of the peaks in the tracing (one cycle)
(2)
1st step :
1.Select preset button to find different options
2.Select cardiac preset
Identify fetal heart....
3. optimize image as big as possible.....
4.Select M mode (motion mode)
It allows operator to evaluate the motion in a lstill image.....
5.Turn on the mode & put the cursor across the heart to see heart beats...
6.Freez image to access the heart in the M mode in the still image...
7.Looking at the still image yu will be able to differentiate b/w systole & diastole....
During systole the LV will contract, & the lumen b/w the 2 walls of the LV will be diminished as opposed to diastole when the LV is relaxed & the lumen will be enlarged in its diameter...
Next step :
In order to get the fetal heart rate on cardiac preset is to choose the RVLD study by …
 (3)
How to get same measurements using abdominal preset as opposed to cardiac prest..
Here NO options like IDRV, but the  *machine has an option called (hr) i.e heart rate
1.Click on it yu identify the fetal heart rate...
2. Choose M mode
3.put cursor of M mode across the heart.
4.freeze the image in the M mode so that yu see the M mode in a still image..
5.yu need to choose 2 cardiac cycles...e.g this is a systole of cardiac cycle No. one, then skip the next systole & choose the next systole so our caliper will involve the 2 full cardiac cycles..
As sson as yu confirm the position of yur 2nd caliper, yu will get the fetal heart rate

 In this video learn how to activate m-mode to get a motion tracing of the fetal heart motion. Fetal Heart Rate can be accurately measured on the m-mode using the OB calculation package.