Lesson 1Landmarks for early pregnancy: gestational sac, yolk sac, fetal pole, decidual reaction, and double decidual signDescribes key sonographic landmarks of early pregnancy, including gestational sac, yolk sac, fetal pole, and decidual reaction, and explains the double decidual sign, normal changes, and expected timing by gestational age.
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 scanning in early pregnancy, including bladder prep, probe setup, standard sagittal and transverse planes, and checking uterine position to support transvaginal imaging or when it's not possible.
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 implicationsExplains systematic check of free fluid in the pelvis and upper abdomen, including key areas, grading amount, and spotting echogenic clot, and links sonographic findings to clinical urgency and possible ectopic break.
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/recordDetails standard measurements and documentation in early pregnancy, including MSD, CRL, and fetal heart rate, with tips on caliper placement, image storage, cine loops, and reporting to support accurate dating and viability check.
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 scanningAddresses safety rules, informed consent, and infection control for transvaginal scanning, including ALARA, chaperone use, probe covers, high-level cleaning, and respectful talk about private 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 clinical reasons for first-trimester pelvic ultrasound and details patient prep, stressing bladder filling for transabdominal scans, no-gos, and fitting approach to symptoms and blood flow status.
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 interrogationOutlines a step-by-step transvaginal scan, stressing probe handling, systematic sagittal and coronal sweeps, and full check of uterus, cervix, and adnexa to best see early pregnancy structures and pelvic issues.
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 neededDefines standard reporting words for viability, dating, and suspected ectopic pregnancy, and outlines suggested follow-up times, warning findings, and rules for urgent gynae or emergency referral to support 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 ultrasound findings that worry for ectopic pregnancy, including adnexal masses, tubal ring, and free fluid, and explains non-seen IUP limits, key beta-hCG levels, and combining with 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 sonographic rules confirming a true intrauterine pregnancy, differing it from pseudogestational sacs, and highlights traps, timing, and link with clinical data to avoid wrong diagnosis and bad management.
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 transducerCovers picking right probes and presets for first-trimester pelvic ultrasound, comparing transabdominal curvilinear and transvaginal transducers, and explains setting frequency, depth, and exam-specific options.
Curvilinear versus endovaginal transducersChoosing frequency for body habitusPreset selection for early pregnancyAdjusting depth, focus, and dynamic rangeHarmonics and resolution versus penetration
