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What does the following ultrasound report indicate?

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Posted on Fri, 12 Aug 2016
Question: Subject: Gynecology (pregnancy and miscarriage)
Hi Doctor,
I am pregnant for 7+ weeks. I have endometriosis. My recent Ultrasound report done on 14 July 2016, is showing that the uterus is anteverted and is gravid with a single gestational sac. Yolk sac is seen within in; however it was not seen in previous USG report done one month back on 14 XXXXXXX the GSD is 24.2 mm (it was 14.7mm). The Trophoblastic reaction is strong in both reports.

The recent concerns are:
1. doctor did not get heart beat of my baby from the recent USG;
2. No obvious fetal pole they have seen in both reports.

Endometriosis:
1. Report on 14 July 2016: this cystic area was about 12.7 X 7.6 X 6.2 CM and its' volume is 318 ml.
2. Previous report done one month back on 14 XXXXXXX 2016: it was about 12.4 X 6.1 X 5.8 CM and its' volume was 236 ml.
I am taking Duphaston 10 mg since 14 XXXXXXX 2016.
Can you please let me know the following:
1. Do I need to go for D&C immediately (as my doctor is suggesting)?
2. Is there any hope for further development?
3. Is there any danger sing if I wait longer for D&C? If I go for miscarriage naturally, is there any complications to get pregnant in future? When will be the time limit for me to do D&C?
4. Can I go for further USG? When I have to do this?
5. is there any restrictions on my movement? I am doing job.
Looking forward to getting your kind response.
doctor
Answered by Dr. Ramadevi Wani (50 minutes later)
Brief Answer:
Details below.

Detailed Answer:
Hi,
Welcome to Healthcare magic.
I am Dr Ramadevi Wani. I appreciate your concerns.

I have read your notes and seen the ultrasound images.

With a gestational sac of 24 mm size, one should be able to see the fetal pole clearly. The sac diameter was 14.7 mm on XXXXXXX 14th. In that case the recent ultrasound ( done after one month) should have shown fetal pole with heart beat. I am extremely sorry to say that this ultrasound is suggestive of miscarriage.

I shall answer your queries now.

1. Do I need to go for D&C immediately (as my doctor is suggesting)?- You can wait for few days , if you wish. You may also discuss about medical abortion ( taking tablets for abortion) with your doctor.

2. Is there any hope for further development?-- I have explained regarding this above. Unfortunately there is no hope for further development.

3. Is there any danger sing if I wait longer for D&C? If I go for miscarriage naturally, is there any complications to get pregnant in future? When will be the time limit for me to do D&C?-There can be complications if you wait too long. If you go for miscarriage naturally, there is no problem with pregnancy in future.

You can wait for a week or so, if you wish.

4. Can I go for further USG? When I have to do this?- I have explained about this above. If you still want further confirmation, you can repeat the ultrasound after a week.

5. is there any restrictions on my movement? I am doing job- There is no restriction on your movements. Just don't exert yourself.

I hope this is helpful.
Wishing you good health and healthy pregnancy next time,
Best wishes,
Dr Rama
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ramadevi Wani (2 days later)
Thanks a lot Dr. XXXXXXX

Recently I have done TVS ultrasound, they are able to find the fetal pole. I did it on 17 July 2016, but the heart beat was absent. I also have done a pregnancy test on 16 July 2016, it shows still positive result.

Please find the following result of my recent test:
Uterus: It is bulky, gravid and anteverted in position. Myometrial echotexture is homogenous. Endometrial cavity contains single gestational sac with FOETAL POLE. Cardiac pulsation is absent.
CRL: 6.1 mm
Corresponding to: 6 weeks 3 days

Adnexa: Right ovary contains cystic area with thick internal echo 66.2 X 67.8 mm. Left ovary contains functional cyst 26.9 X 28.4 mm.

Comments made by doctor: Early intrauterine pregnancy about 6-7 weeks with right ovarian chocolate cysts.

My Question to you:
1. As the Yolk sac and fetal pole is found, is there any positive change? Please be informed that there are few error in my last USG. And I don't feel any bleeding, spotting, cramp or pain at my lower abdomen and lower back.

2. Shall I wait more to get the heart beat? If I delayed, is there any life risk e.g., excessive bleeding. How long I can wait?

3. Is my Endometriosis is responsible for all these negative impact on my pregnancy? Has my left ovary affected as well? Should I need to remove this as soon as possible? Does the surgery have any impact on my future pregnancy? Which method I need to take for surgery?

4. Is my following medication appropriate?

Medication I am taking at present:
I have changed my previous medication. Now I am taking:
1. Microgest (100 mg) for 1 + 0 + 1 . two times daily
2. Vitamin B supplement for 1 + 0 + 1 . two times daily
3. Folic acid. once daily (at night)
4. Pantobex (20 mg) for 1 + 0 + 1 . two times daily before meal

Kindly share your kind feedback.

Best regards, XXXXXXX
doctor
Answered by Dr. Ramadevi Wani (11 hours later)
Brief Answer:
Details below

Detailed Answer:
Hi Mrs XXXXXXX

Welcome back.
My answers to your questions are as below
1. As the Yolk sac and fetal pole is found, is there any positive change? Please be informed that there are few error in my last USG. And I don't feel any bleeding, spotting, cramp or pain at my lower abdomen and lower back.

ANS-Finding yolk sac and fetal pole is definitely a positive sign. Normally fetal heart beat is seen when CRL is 6mm. Rarely it is not seen. I suggest repeat the ultrasound on 24th. That will be the final ultrasound. You must see the fetal heart activity in that sonar.

2. Shall I wait more to get the heart beat? If I delayed, is there any life risk e.g., excessive bleeding. How long I can wait?

ANS-There is no risk in waiting for a week.

3. Is my Endometriosis is responsible for all these negative impact on my pregnancy? Has my left ovary affected as well? Should I need to remove this as soon as possible? Does the surgery have any impact on my future pregnancy? Which method I need to take for surgery?

ANS- Endometriosis may delay the pregnancy. But once pregnancy occurs it is no different from normal. So do not worry.
In my opinion it is better to remove the endometriotic cyst and tissue. Once you decide it is better to get it done early.
Go for laparoscopic surgery. This surgery needs skilled experienced laparoscopic surgeon. Laparoscopic surgery will not have any negative impact on your future pregnancy.

4. Is my following medication appropriate?

ANS: Your medicines are appropriate. Why are you taking Pentobex? Do you have burning in the stomach or acidity? If you do not have these symptoms, there is no need to take Pentobex. Take rest of the medicines.

If you have further concerns, I will be happy to answer.
Wishing you good health and healthy pregnancy,
Best wishes,
Dr Rama
Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
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Dr. Ramadevi Wani

OBGYN

Practicing since :1985

Answered : 1445 Questions

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What does the following ultrasound report indicate?

Brief Answer: Details below. Detailed Answer: Hi, Welcome to Healthcare magic. I am Dr Ramadevi Wani. I appreciate your concerns. I have read your notes and seen the ultrasound images. With a gestational sac of 24 mm size, one should be able to see the fetal pole clearly. The sac diameter was 14.7 mm on XXXXXXX 14th. In that case the recent ultrasound ( done after one month) should have shown fetal pole with heart beat. I am extremely sorry to say that this ultrasound is suggestive of miscarriage. I shall answer your queries now. 1. Do I need to go for D&C immediately (as my doctor is suggesting)?- You can wait for few days , if you wish. You may also discuss about medical abortion ( taking tablets for abortion) with your doctor. 2. Is there any hope for further development?-- I have explained regarding this above. Unfortunately there is no hope for further development. 3. Is there any danger sing if I wait longer for D&C? If I go for miscarriage naturally, is there any complications to get pregnant in future? When will be the time limit for me to do D&C?-There can be complications if you wait too long. If you go for miscarriage naturally, there is no problem with pregnancy in future. You can wait for a week or so, if you wish. 4. Can I go for further USG? When I have to do this?- I have explained about this above. If you still want further confirmation, you can repeat the ultrasound after a week. 5. is there any restrictions on my movement? I am doing job- There is no restriction on your movements. Just don't exert yourself. I hope this is helpful. Wishing you good health and healthy pregnancy next time, Best wishes, Dr Rama