Lesson 1Landmarks for early pregnancy: gestational sac, yolk sac, fetal pole, decidual reaction, and double decidual signDescribes main sonographic markers of early pregnancy, like gestational sac, yolk sac, fetal pole, decidual reaction, and the double decidual sign, with normal progression and timing by gestation.
Normal appearance of gestational sacYolk sac morphology and size limitsFetal pole visualisation and timingDecidual reaction and double decidual signChronology of expected early findingsLesson 2Transabdominal acquisition: standard sagittal and transverse pelvic planes and uterine orientationCovers transabdominal pelvic scans in early pregnancy, including bladder prep, probe setup, standard planes, and uterine position assessment to aid transvaginal imaging or when contraindicated.
Bladder filling and patient positioningMidline sagittal pelvic overviewTransverse pelvic sweep and adnexal surveyIdentifying uterine version and flexionOptimising depth, focus, and gain settingsLesson 3Assessment of free fluid in pelvis: location (Morison, pouch of Douglas), quantification, and clinical implicationsDetails pelvic and upper abdominal free fluid checks, key areas, volume grading, echogenic clot recognition, and ties findings to urgency like possible ectopic rupture.
Scanning pouch of Douglas and paracolic guttersRight upper quadrant and Morison’s pouchCharacterising anechoic versus complex fluidSemi-quantitative grading of free fluidImplications for suspected ectopic ruptureLesson 4Measurements and documentation: mean sac diameter (MSD), crown-rump length (CRL), fetal heart motion and how to measure/recordSpecifies standard measurements and docs in early pregnancy, like MSD, CRL, fetal heart rate, with caliper tips, storage, and reporting for dating and viability.
Mean sac diameter technique and pitfallsCrown-rump length and dating chartsFetal heart rate measurement methodsImage labelling and cine loop storageIntegrating measurements into reportsLesson 5Safety, informed consent and infection control for transvaginal scanningCovers safety, consent, and infection control for transvaginal scans, including ALARA, chaperones, probe covers, disinfection, and sensitive communication for intimate exams.
ALARA and first-trimester safety indicesObtaining and documenting informed consentChaperone policies and patient dignityProbe covers, gel use, and barrier methodsHigh-level disinfection and traceabilityLesson 6Clinical indications, patient preparation: bladder filling protocols for transabdominal scanReviews indications for first-trimester pelvic ultrasound and prep details, emphasising bladder filling for transabdominal, contraindications, and adapting to symptoms and stability.
Common indications in early pregnancyContraindications and relative limitationsBladder filling volumes and timingExplaining procedure and managing anxietyAdapting protocol to unstable patientsLesson 7Transvaginal acquisition: systematic sagittal and coronal views, uterine fundus-to-cervix sweep, adnexal interrogationProvides step-by-step transvaginal scanning, stressing probe handling, sagittal and coronal sweeps, and full uterus, cervix, adnexa review for early pregnancy and pathology.
Patient positioning and probe insertion techniqueMidline uterine sagittal sweep fundus to cervixParamedian sagittal sweeps for uterine hornsCoronal plane acquisition and optimisationSystematic adnexal and cul-de-sac interrogationLesson 8Reporting language for viability, dating, and suspected ectopic pregnancy; recommended follow-up intervals and when urgent referral is neededSets standard reporting for viability, dating, ectopic suspicion, follow-up timing, alerts, and urgent referral criteria for safe care.
Structured report elements for early pregnancyStandard terms for viability and uncertaintyDating statements and measurement reportingSuggested follow-up and repeat scan timingWhen to escalate for urgent specialist reviewLesson 9Findings suggesting ectopic pregnancy: adnexal mass characteristics, tubal ring, and non-visualised IUP thresholds and beta-hCG correlationDetails ectopic indicators like adnexal masses, tubal ring, free fluid, nonvisualised IUP thresholds, beta-hCG levels, and clinical risks.
Typical tubal ring and adnexal mass patternsRing of fire and vascularity assessmentFree fluid patterns and haemoperitoneumDiscriminatory beta-hCG and absent IUPPregnancy of unknown location algorithmsLesson 10Criteria to confirm intrauterine pregnancy versus pseudogestational sacExplains criteria for true intrauterine pregnancy vs pseudosac, pitfalls, timing, and clinical ties to prevent errors.
Sonographic features of true gestational sacDouble decidual and intradecidual signsCentral fluid collections and pseudosacsRole of yolk sac and fetal pole visualisationCorrelation with symptoms and serial beta-hCGLesson 11Probe selection and machine presets: transabdominal curvilinear and transvaginal endovaginal transducerDiscusses probe and preset choices for first-trimester pelvic ultrasound, comparing transabdominal curvilinear and transvaginal, with frequency, depth, and setting optimisation.
Curvilinear versus endovaginal transducersChoosing frequency for body habitusPreset selection for early pregnancyAdjusting depth, focus, and dynamic rangeHarmonics and resolution versus penetration
