Ultrasound Follow-Up in Early Pregnancy

In patients with recurrent pregnancy loss (RPL), a normal early pregnancy scan can be highly reassuring, whereas abnormal findings can give clues about adverse pregnancy outcomes, including pregnancy loss. Transvaginal sonography (TVS) is a very useful adjunct. The primary goals of first-trimester ultrasound are to determine whether the pregnancy is intrauterine, the number of embryos, viability, gestational age assessment, chorionicity in multiple pregnancies, aneuploidy screening, and to rule out structural abnormalities. It is also important to rule out uterine anomalies, fibroids, and adnexal pathology. International bodies have given diagnostic criteria for early pregnancy loss. Where there is any doubt about such a diagnosis, USG should be performed at an interval of at least 1 week from the initial scan before medical or surgical measures are undertaken for uterine evacuation. The presence of a retroplacental hematoma (especially below the cord insertion) is significantly correlated with an increased risk for adverse pregnancy outcomes, such as miscarriage, pregnancy-induced hypertension, placental abruption, and other placental dysfunction disorders. Nuchal translucency has emerged as a powerful screening tool for chromosomal/genetic/cardiac anomalies along with other markers in the 11–14-week scan. A significant proportion of major structural malformations can be diagnosed at the 11–14-week scan.