E2079. Troubleshooting in Early Pregnancy Diagnosis: Challenging Ultrasound Cases from a County Hospital
  1. Jonathan Barclay; UCLA
  2. Gail Hansen; Olive View Hospital
  3. Denise Andrews-Tang; Olive View Hospital
  4. Karoly Viragh; Olive View Hospital
The evaluation of early normal and abnormal pregnancy is a commonly encountered problem in sonography. Correct diagnosis and appropriate management are critical due to the inherent patient-stress and risk of maternal morbidity and mortality. The purpose of the exhibit is to provide a problem-based practical review of early pregnancy through challenging cases seen in a high-volume county hospital. Each case is carefully selected to teach a practical pearl in troubleshooting complex and unusual presentations. Sonographic and clinical correlation is provided.

Educational Goals / Teaching Points
1. Illustrated review of the anatomy of the female reproductive tract and the stages of normal early pregnancy with sonographic correlation. 2. Review of common clinical dilemmas and their management with reference to major professional societal guidelines (WHO, ACOG, SRU/ACR), including abnomal/non-viable intrauterine pregnancy, ectopic/heterotopic pregnancy, and pregnancy of unknown location. 3. Sonographic and clinical pearls for optimal diagnosis.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
In the first part, general principles will be reviewed, including diagnostic tools and normal/abnormal physiology. The most important imaging tool for evaluating and confirming early pregnancy is transvaginal pelvic ultrasound (US) together with relevant clinical history and lab results, therefore technical pearls and pitfalls will be provided. Basic understanding of the normal physiology of early pregnancy is necessary for successful diagnosis, including the anatomical location of fertilization and implantation, the corresponding serologic changes, as well as the expected sonographic appearance. Sonographic signs of early pregnancy as well as viability/non-viability criteria with proper terminology will be discussed and illustrated. The natural course of normal and abnormal early pregnancy will be briefly described with expected clinical management and possible complications. In the second part, challenging cases will be presented in a quiz-like format to illustrate dilemmas in identifying early normal pregnancy (for example, fetal pole may not yet be visible), non-viable pregnancy (illustration of guidelines), uncomplicated and complicated ectopic pregnancy (tubal, scar, cervical, ovarian, abdominal, heterotopic), pregnancy of unknown location, and other puzzling scenarios (multiple corpus luteal cysts vs. ectopic, generalized abdominal pain with free fluid).

Knowing how to troubleshoot difficult early pregnancy cases leads to better patient care.