Perigestational hemorrhage in the exam

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Getting a film with pregestational hemorrhage in the exam is one of the many exam set-pieces that can be prepared for.

Description

Transabdominal and transvaginal (TV) pelvic ultrasound shows an anteverted uterus with an intrauterine gestational sac. MSD is 20 mm in TV study with a single, live embryo (CRL = 5 mm, HR = 140 bpm) and a yolk sac consistent with 6 weeks of gestation. There is a 52 mm hypoechoic area adjacent to the sac which covers about 50% of the sac surface consistent with a perigestational hemorrhage.

The cervix is long and closed. Both ovaries are normal with no adnexal masses or free fluid. I would recommend a follow-up scan in 5-7 days to ensure, normal growth and development.

Notes

  • occurs in 20% of patients with per vaginal bleeding and 3% of all first-trimester patients
  • a small hemorrhage surrounding <20% of the gestational sac and a large one surrounds >50% of the sac
Exam technique