ULTRASOUND Messages for August, 2002: Re: intrauterine echoic

Re: intrauterine echoic

From: Terry J DuBose

tjdubose@juno.com

Sun Aug 25 08:08:21 2002

When the ER physician said that "fetal heart tones" were found, did that mean that they used sonography or a stethoscope? Martin and Dr. Worrall are correct that you can not auscultate heart tones at this age by stethoscope, or was sonography used to detect heart tones? By endovaginal sonography you can pick up the embryonic heart rate (EHR) by the early 5th week after the LMP, and occasionally as early as the late 4th week (about 4.8 weeks with really good images). Basically, if you can see the EHR you are seeing the embryonic pole... that mass is the embryo. Often you will see it as a "double bleb" depending upon the angle of the plane of view, one part being the yolk sac.

I am assuming that you did not record the EHR via M-mode, which is what I always recommend. Also, Martin mentioned checking the mother's pulse, which is a good idea; however, rather than "grab the patient's wrist" I prefer to simply angle the M-mode vector into the maternal adnexa and get an M-mode from one of the maternal (iliac) arteries. M-mode is much more accurate than your ear, eye, or finger for measuring pulses. This becomes important because the in the late 4th-early 5th week the embryo's pulse may be near the mother's (see the following articles).

Assuming that you will reexamine the woman and her pregnancy, please do record the EHR via M-mode, calculate the GA via CRL & EHR, as Martin mentions, to see if the ages correlate as the following articles discuss.

We will be anxiously awaiting images and more information as the case progresses... this is the real strength of this kind of Web site, the ability to communicate quickly, with images, and get advice from around the world. It is a new paradigm for medicine.

Peace, Terry J DuBose, M.S., RDMS Little Rock, Arkansas USA

On Fri, 23 Aug 2002 19:24:50 -0500 bshabrown1@aol.com (Sharon Brown) writes: > I need info if posible. Last week I was sent a patient from the ER,
> in
> which the doc told the woman that he found fetal heart tones. I did
> a
> transvag and found a gestational sac with a yolk sac within.
> However,
> hard as I looked I couldn't find a fetal pole. As I was scanning
> the
> uterus I found what the doc was talking about. The problem is that
> the
> fetal pole that I found was outside of the gestational sac and it
> did
> have heart motion, it was also hyperechoic. I am completely
> baffeled by
> this, and the Rad that I showed the images and talked with couldn't
> quite figure it out either. How is it possible that a fetus can
> reach
> the 6-7 week stage outside of the gestational sac, and what would
> cause
> it to implant outside of the endometrious, yet still within the
> uterus.
> It was in the area where one would normally find a sub chorionic
> bleed.
> The fetal pole and the yolk sac both measured 4 mm. Any help would
> be
> appreciated. Thanks Sharon
>

Women's Insurance Checklist from Auto Insurance Quote

use when must restrict search to only the ultrasound forum...
Enter search keywords:
	Returns per screen: Require all keywords: