1st Trimester sonography

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Routine examination checklist

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NT examination checklist

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Early Doppler examination checklist

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Early fetal echocardiography examination checklist

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Dating & viability scan

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First trimester anatomical survey

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Early growth & serial dating

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First-trimester follow-up plan

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Chorionicity & amnionicity assessment

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NT Screening

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First trimester Doppler scan

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Early fetal echocardiography

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Biochemical markers

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Empty sac sign

Empty sac sign refers to a gestational sac seen within the uterus without a visible yolk sac or embryo on transvaginal ultrasound, usually when mean sac diameter (MSD) ≥ 25 mm without embryonic structures. It suggests an anembryonic pregnancy (blighted ovum).

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Empty-amnion sign

Empty-amnion sign describes the presence of an amniotic sac without a visible embryo within it. It indicates an arrested early embryonic development where the amnion has formed but the embryo has failed to develop or has been resorbed.

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Anembryonic pregnancy

Anembryonic pregnancy (blighted ovum) is a failed early pregnancy where a gestational sac develops but the embryo does not form. Diagnosis is made when the MSD ≥ 25 mm with no embryo or yolk sac visible on high-resolution transvaginal ultrasound.

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Embryonic cardiac activity is not detected

Absence of embryonic cardiac activity is a key sign of non-viable pregnancy. If the crown–rump length (CRL) ≥ 7 mm and no heartbeat is observed on transvaginal ultrasound, it confirms embryonic demise per SRU/AIUM guidelines.

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Failure of Interval Growth in germinal age

Failure of interval growth during the germinal stage (up to 6 weeks) refers to the lack of expected increase in gestational sac size or yolk sac development between serial scans, indicating early pregnancy failure or arrested implantation.

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Failure of Interval Growth in embryonic age

Failure of interval growth in the embryonic phase (6–10 weeks) indicates absent or subnormal increase in CRL, yolk sac, or gestational sac over 7–10 days, suggesting embryonic demise or threatened miscarriage.

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Embryonic demise / Miscarriage

Embryonic demise (missed miscarriage) occurs when an embryo is visualized without cardiac activity. The gestational sac and embryo remain in situ, but no viable signs persist. Often confirmed on repeat scan after 7 days with no interval growth.

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Inevitable miscarriage

Inevitable miscarriage is diagnosed when there is cervical dilatation with or without visible products of conception in the cervical canal, accompanied by active vaginal bleeding and cramping, indicating imminent pregnancy loss.

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Incomplete miscarriage / RPOC

Incomplete miscarriage or retained products of conception (RPOC) refers to partial expulsion of gestational tissue with some retained material within the uterine cavity, appearing as echogenic or vascular remnants on ultrasound.

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Complete miscarriage

Complete miscarriage indicates total expulsion of gestational tissue. The uterus appears empty with a thin endometrial stripe (<10 mm) and no vascularity on color Doppler. Clinical correlation confirms passage of all tissue.

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Hydropic abortion

Hydropic abortion describes an abnormal miscarriage where villi become edematous, mimicking molar tissue. Sonographically, it appears as heterogeneous intrauterine echoes with cystic spaces, but β-hCG levels are not markedly elevated.

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Chorionic bump

Chorionic bump is a focal, nodular protrusion from the choriodecidual surface into the gestational sac, possibly representing a small hematoma. It may be associated with increased risk of miscarriage but can resolve spontaneously.

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Complete Hydatidiform Mole

Complete hydatidiform mole results from fertilization of an empty ovum by a haploid sperm that duplicates its DNA. Ultrasound shows a ‘snowstorm’ or ‘cluster of grapes’ pattern with diffuse echogenic material and no fetus or amnion.

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Partial Hydatidiform Mole

Partial mole results from triploidy (two paternal and one maternal chromosome set) leading to an abnormal fetus with molar placenta. Ultrasound shows focal cystic changes in the placenta with a malformed embryo or gestational sac.

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Coexisting partial hydatidiform mole

Coexisting partial hydatidiform mole refers to a twin gestation where one sac is normal and the other is molar. Sonographically, one live fetus coexists with molar tissue, requiring close follow-up due to high risk of hemorrhage and GTD.

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Sub-chorionic hemorrhage

Subchorionic hemorrhage is a common cause of early pregnancy bleeding, appearing as a crescent-shaped hypoechoic or echogenic collection between the chorion and uterine wall. Large or persistent collections increase miscarriage risk.

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