The first-trimester ultrasound is an exciting event for clinicians, carrying patients, and their families. All know, however, that this exciting time may also be when complications are discovered or diagnosed. This FAQ offers answers to many questions that surround the first-trimester ultrasound, from confirming a pregnancy to assessing for risk and fetal anomalies.
- When should I send my patient to an obstetrician? Patients are referred for obstetrical care after a positive pregnancy confirmation exam. Confirming a pregnancy is a two-step process involving human chorionic gonadotropin (hCG) measurements and transvaginal ultrasound. Learn more about how often to measure hCG and how to perform a transvaginal ultrasound to meet the International Society of Ultrasound in Obstetrics and Gynecology guidelines.
- Do IVF patients want honest answers about first-trimester risks and tests? Following in vitro fertilization (IVF), pregnant patients rely on their clinicians to provide accurate information and statistics, but in a way that's sensitive to their fears of possible pregnancy loss. This article will help obstetricians learn the kind of information their patients want (and need) to hear, especially at the first-trimester exam, and how to be honest yet supportive during this sensitive time.
- Can ultrasound help reduce the risk of ectopic pregnancies? Patients who undergo IVF have an increased risk of ectopic pregnancy. Newer 3D and 4D ultrasound technology help with more accurate embryo placement and can allow the physician to see whether (and how) the embryo has migrated after placement.
- How common is first-trimester bleeding, and when is it concerning? As many as one-quarter of pregnant patients experience first-trimester bleeding. Although bleeding may be normal, it can also sometimes signal a problem, such as infection, subchorionic hemorrhage, or even an ectopic pregnancy. Learn more about first-trimester bleeding, including possible causes and how to respond when it's detected.
- Is blood/DNA testing or ultrasound more useful for detecting trisomy 21 in the first trimester? When it comes to identifying pregnancies at high risk for trisomy 21, no testing method should stand alone. Maternal serum and cell-free DNA testing have a place in identification, as do screenings by ultrasound — which can detect enlarged nuchal translucency and other associated anomalies. Learn more about the value of ultrasound in diagnosing and monitoring this condition.
- Should I ask pregnant patients about cannabis use? Yes, OB/GYNs should ask carrying patients about cannabis use as early as possible. Although research on cannabis and pregnancy is somewhat limited, it has been linked to conditions such as low birth weight, developmental delays and even stillbirth. Review updated guidance from the American Journal of Obstetrics and Gynecology regarding cannabis use and how clinicians can open a dialogue on the topic with their carrying patients.
- When is bleeding concerning after early pregnancy loss? Vaginal bleeding after early pregnancy loss — but also after a normal delivery, or D&C — can signal a number of problems. Extended bleeding warrants a thorough workup to pinpoint the cause. This "medical mystery" case study presents a 36-year-old woman with persistent vaginal bleeding three weeks after what she thought was a miscarriage. What should the diagnosis be?
Early pregnancy can be an exciting yet anxious time, and patients will likely have many questions during their first-trimester ultrasound. Clinicians who are ready with answers, and deliver them with compassion, will succeed in reassuring their patients that they are receiving the best care possible.
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