Ultrasound

Key Point

• Routine screening ultrasound in low-risk pregnancies is not associated with a decrease in perinatal mortality, birth weight, or preterm birth.

With high-resolution vaginal sonography, a normal singleton pregnancy can be seen by 5V2 to 6 weeks of pregnancy (1V2 to 2 weeks after the missed period). By this time, the quantitative hCG level has reached the discriminatory zone, or the level above which a gestational sac is always visualized. The discriminatory zone may vary from institution to institution because of differences in equipment and assays, but ranges from 800 to 1000 IU/L (Second International Standard), or 1000 to 2000 IU/L (First International Reference Preparation) (Nyberg et al., 1985; Peisner and Timor-Tritsch, 1990).

As many as 20% to 30% of ectopic gestations have no detectable sonographic abnormality. The typical ultrasound findings for ectopic pregnancy are a unilateral mass, fluid in the cul de sac, and no evidence of intrauterine pregnancy. Conclusive diagnosis of an ectopic gestation by sonography can only be made if a fetus or fetal cardiac motion is seen outside the uterus. With vaginal ultrasound, this only occurs in about 20% of ectopic pregnancies.

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