Early pregnancy complications

a. Normal early intrauterine pregnancy

Normal early intrauterine pregnancyUltrasound scans are usually performed in early pregnancy when women experience problems such as abdominal pain or vaginal bleeding.  However, in women with no symptoms who suffered miscarriages or ectopic pregnancy in the past, ultrasound scans are helpful to confirm that the pregnancy is located inside the uterine cavity and that it is developing normally.  An ultrasound scan can identify pregnancy inside the uterus 17 days after the egg was released from the ovary (ovulation).  This is approximately three days after a missed period in a woman with regular menstrual cycles.  A pregnancy test, however, becomes positive three days before the period is missed. Some women tend to perform a pregnancy test very early, before the pregnancy can be seen on the scan.  In such situations a blood test to measure levels of pregnancy related hormones helps to estimate the age of pregnancy and determine when the pregnancy can be seen on the scan.

For the first two weeks after a missed period early pregnancy appears on the scan as a small fluid filled bubble. The embryo can first be seen two weeks after the missed period (i.e. at six weeks’ gestations calculated from the date of the last menstrual period in a woman with regular 28 day cycles), and if the pregnancy is normal, heart pulsations can also be seen at the same time. Presence of normal heart rate is a very reassuring sign, which indicates that the risk of pregnancy miscarrying is very small. From then on the embryo grows very quickly and three weeks after a missed period head and body can be seen on the scan. Four weeks after the missed period many fine details of the embryo can be seen including various normal brain structures and limb buds.

b. Miscarriage

MiscarriageIn recent years ultrasound has become the mainstay of diagnosis of miscarriage and is offered routinely to any woman who experience symptoms suspicious of miscarriage. Ultrasound diagnosis of miscarriage is not always easy and sometimes repeated scans and blood tests may be required before a conclusive diagnosis of pregnancy loss can be made. In many cases of miscarriage pregnancy tissue is removed naturally from the uterus by strong contractions. Ultrasound is helpful, however, to determine whether the natural process of miscarriage has been successful or whether surgery or medical intervention may be required to facilitate recovery.

c. Ectopic pregnancy

Ectopic pregnancyPregnancies which are located outside the uterine cavity are described as ectopic pregnancies. They are relatively rare and they occur in 1-2% of all pregnancies. The most common location of ectopic pregnancy is in the Fallopian tube, but they may occur anywhere in the pelvis. Risk factors for ectopic pregnancy are past history of pelvic infection, history of infertility and increased maternal age. Women who had an ectopic pregnancy in the past are at particularly high risk of developing another ectopic pregnancy.

Ultrasound is the only method which provides a reliable diagnosis of ectopic pregnancy prior to surgery. All our consultants have expertise in ultrasound diagnosis of ectopic pregnancy. In some women ectopic pregnancy may lead to serious internal bleeding and prompt, accurate diagnosis helps to avoid delays in referring women for emergency surgery. A majority of women with ectopic pregnancies present with mild symptoms, which do not require immediate operation. In these cases ultrasound helps to identify those women in whom ectopic pregnancy is likely to resolve naturally without causing harm. Our consultants have been in the forefront of research in the management of ectopic pregnancy for many years and have developed a diagnostic approach which helps more than a third of women with ectopic pregnancies to overcome the condition without needing surgery or medical treatment.

We also have particular interest in the diagnosis and management of rare and unusual forms of ectopic pregnancy such as cervical, interstitial and cornual pregnancy. Our team is particularly well known for their expertise in the diagnosis and management of Caesarean scar ectopic pregnancy and we regularly see women with this condition who are referred to us from all parts of the UK and many European countries.