Worrisome Findings (1st Trimester)

Worrisome Findings (1st Trimester)

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Worrisome findings in the first trimester ultrasound refer to abnormal or suspicious sonographic features that may indicate a failing, nonviable, or ectopic pregnancy. These findings help identify pregnancies at risk for miscarriage, chromosomal abnormalities, molar changes, or implantation outside the uterus. Early detection is crucial for guiding further evaluation, patient counseling, and timely management.

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Worrisome Findings (1st Trimester)

• Empty gestational sac >25 mm (no yolk sac or embryo)
• Crown-Rump Length (CRL) >7 mm with no fetal cardiac activity
• No embryo seen ≥6 weeks gestational age (by LMP)
• No cardiac activity after 6.5 weeks or CRL ≥5 mm
• Abnormally shaped gestational sac (irregular or collapsed)
• Low-positioned gestational sac (near cervix or lower uterine segment)
• Thin or weak decidual reaction (<2 mm)
• Large yolk sac (>6 mm) or small yolk sac (<2 mm)
• No yolk sac seen when gestational sac >20 mm
• Subchorionic hemorrhage (especially if large or expanding)
• Bradycardia (<100 bpm at 6–7 weeks gestation)
• Embryonic tachycardia (>180 bpm)
• Discrepant sac and embryo size (poor growth)
• Gestational sac growth <1 mm/day
• CRL not increasing >1 mm/day
• Empty amnion sign (amnion visible but no embryo inside)
• Pseudogestational sac (associated with ectopic pregnancy)
• Free fluid in pelvis or adnexa (concern for ectopic pregnancy or rupture)
• Adnexal mass suggestive of ectopic pregnancy (tubal ring sign, yolk sac outside uterus)
• Absent double decidual sac sign
• Abnormal trophoblastic reaction (thin, irregular, or asymmetric)
• Blighted ovum (anembryonic gestation)
• Hydropic changes (suggestive of molar pregnancy)
• Gestational trophoblastic disease (snowstorm appearance)
• Multiple gestations with discordant growth or vanishing twin
• Uterine or adnexal abnormality affecting pregnancy