Presentation
Spotting and pelvic discomfort. Positive pregnancy test.
Patient Data
Tiny rounded hypoechoic structure located eccentrically within the anterior endometrium, adjacent to the central endometrial stripe ( not measured). Right corups luteum present.
Hypoechoic structure seen on prior scan has now increased in size and demonstrates a double decidual sign of a gestational sac. MSD 4.5mm. No yolk sac or embryonic pole.
No perigestational hemorrhage.
Right CL persists.
A yolk sac and very early embryonic pole are now seen (CRL 1.9mm). No cardiac activity demonstrated at this stage. This remains a pregnancy of uncertain viability.
Case Discussion
Three scans demonstrating the very early progression of ultrasound appearances.
The very short follow-up period between the first and second scan was probably prompted by some uncertainty as to whether the tiny cyst in the endometrial cavity represented a gestational sac (ie, the case of treated initially as a pregnancy of unknown location).
Note however that its location is typical for a gestational sac, demonstrating the intradecidual sign.
Furthermore, Doubilet has previously shown that if a nonspecific intrauterine fluid collection is seen in a woman with a positive pregnancy test, the probability of it being a gestational sac is more than 99.5%1. Therefore, provided the patient remained clinically well and with the reassurance of appropriate early bHCG rise, it would have been appropriate to delay the repeat scan to at least 14 days later.
Note that in this case, the scan performed on day 13 still does not prove viability, despite the presence of a very early embryo.
Patient went on to a normal pregnancy and term delivery.
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