Why is early pregnancy ultrasound done, is it abdominal or vaginal, and what can be seen? General information on pregnancy of unknown location and safety.
An early pregnancy ultrasound is imaging done to assess whether the pregnancy is inside the uterus, how many pregnancies there are and the early signs of development. An early pregnancy ultrasound is often considered in the first weeks of pregnancy; however, the doctor decides when the ultrasound will be done according to your complaints and history, and it should not be thought of as a compulsory investigation done at the same time in every pregnancy. The ultrasound can be done over the abdomen, through the vagina or by both. When looked at very early, some findings may not yet be distinguishable and the doctor may ask for a follow-up ultrasound; this on its own does not mean a bad result.
Why are the location and number of the pregnancy assessed on ultrasound?
In early pregnancy, ultrasound may be recommended to confirm that the pregnancy is developing inside the uterus. The same imaging also shows whether the pregnancy is single or multiple. Knowing the location of the pregnancy matters in planning the next steps, particularly when there is pain and bleeding.
Does ultrasound help determine the week of pregnancy?
Research done shows that routine early ultrasound makes pregnancy dating more accurate. How the week is calculated, and whether it will be updated according to the ultrasound finding, is your doctor's assessment.
Is the first ultrasound done at the same time for everyone?
Ultrasound can be planned at different periods throughout pregnancy; the timing of the first ultrasound varies from person to person. Reasons such as pain, bleeding or a problem in earlier pregnancies may lead the doctor to an earlier look. If you have no complaints, timing is determined according to the general monitoring plan.
How are abdominal and vaginal ultrasound done?
In abdominal ultrasound the probe is placed over the abdominal wall. In vaginal ultrasound, a thin probe is placed in the vagina; because it is closer to the uterus in early pregnancy, it is often preferred for image quality. The doctor decides which route will be chosen; sometimes the two routes are used together. If you feel discomfort during the procedure, you can tell the person performing it.
How should you prepare before the ultrasound?
Whether the bladder needs to be full or empty varies with the method to be used. You can ask about this when you make the appointment.
According to what can the gestational sac and the embryo be seen?
According to how far the pregnancy has progressed, the gestational sac is first, and then the embryo, distinguishable on ultrasound. Whether these structures are seen is closely related to the period being looked at. For this reason what will be seen on the ultrasound varies with the week of pregnancy at which it is looked at.
What does it mean if cardiac activity is seen or not seen?
The cardiac activity of the embryo is assessed among the early signs of development. However, cardiac activity seen on a single ultrasound gives no assurance for the rest of the pregnancy; monitoring continues after the first ultrasound. Likewise, cardiac activity not yet being seen does not on its own mean that the pregnancy has ended; when it is not seen, the doctor determines the follow-up plan.
Why may a follow-up ultrasound be requested when looked at very early?
In a very early period some findings may not yet be distinguishable. In this case the doctor may request a follow-up ultrasound after a time and, if necessary, a blood test. A repeat look does not have to mean there is a problem; most of the time it only allows development to be followed over time. The doctor determines when it will be looked at again.
What happens if no pregnancy is seen on ultrasound while the pregnancy test is positive?
This situation is described as "pregnancy of unknown location". Your pregnancy test is positive, but a pregnancy has not yet been detected on ultrasound. In this case the pregnancy may be an early pregnancy inside the uterus, it may be a miscarriage, or it may be an ectopic pregnancy. Which it is is generally clarified by repeating the ultrasound and by blood tests done at regular intervals.
Is early pregnancy ultrasound safe?
Research done concludes that ultrasound used in pregnancy is largely safe. The same research recommends that exposure be kept as low as possible (the ALARA principle) and that the device's output indicators be monitored; it also points to the lack of large randomised studies and to the differences between studies as limitations. For this reason an absolute assurance cannot be given for ultrasound; but it can be said that an examination that is done when necessary and lasts as long as necessary is generally regarded as safe.
What happens after the ultrasound?
After the ultrasound, the doctor assesses the findings together with your history and complaints. If the findings are at the expected level, the monitoring plan continues; if there is uncertainty, a follow-up ultrasound or additional tests may be requested. The timing and scope of later ultrasounds and screening tests are planned by the doctor.
How can you prepare for the ultrasound consultation, and what can you ask your doctor?
- Bring the date of your last period and, if you have them, your earlier ultrasound reports.
- Tell the doctor about a loss, an ectopic pregnancy or any other problem you had in earlier pregnancies.
- Ask whether the ultrasound will be done over the abdomen or through the vagina and whether preparation is needed.
- If the findings are not yet clear, find out in which situation and how the follow-up is planned.
- Review with the doctor which symptoms mean you should seek care without waiting until the day of the follow-up.
Frequently Asked Questions
Can an ectopic pregnancy be detected on early ultrasound?
Vaginal ultrasound is a method known to be more accurate than abdominal ultrasound in diagnosing ectopic pregnancy. Even so, in the early period ultrasound does not always give a definite answer; if the pregnancy cannot yet be seen, the possibility of ectopic pregnancy cannot be regarded as ruled out by this ultrasound.
Can twins or a multiple pregnancy be detected on early ultrasound?
According to research done, routine ultrasound done in the early period reduces the likelihood of a multiple pregnancy being missed. Because in a very early period the findings may not yet be distinguishable, your doctor may request a follow-up ultrasound if necessary.
Does routine early ultrasound improve the baby's health in every pregnancy?
In research done, routine ultrasound has not been shown to reduce adverse outcomes for babies or the use of health services, and no significant difference was found in the perinatal death rate. The same research draws attention to the fact that the timing and frequency of screening in the studies were very different and recommends care in interpretation. For this reason the timing and necessity of early ultrasound are determined by your doctor according to your complaint, your history and your monitoring plan.
Is the first ultrasound done in the same week in every pregnancy?
No. Information such as pain, bleeding and your earlier pregnancy history affects the timing. If you have no complaints, ultrasound is determined according to your general monitoring plan.
Can abdominal and vaginal ultrasound be done together?
Yes. If the doctor thinks it necessary, the two routes can be used together. Vaginal ultrasound is often preferred for image quality because of its closeness to the uterus in early pregnancy.
Is it essential for my bladder to be full before the ultrasound?
This varies with the method to be used. Ask when you make the appointment whether your bladder should be full or empty.
If cardiac activity has not yet been seen, has the pregnancy ended?
This conclusion cannot be drawn on its own. It may have been looked at very early; your doctor determines the follow-up plan.
Does seeing cardiac activity give assurance for the continuation of the pregnancy?
No. A finding on a single ultrasound does not secure the rest of the pregnancy. Monitoring continues after the first ultrasound.
Does a follow-up ultrasound being requested necessarily mean there is a problem?
No. In the early period some structures may not yet be distinguishable. A repeat look can allow development to be assessed over time.
If no pregnancy is seen on ultrasound while my test is positive, is it thought only to be early?
No. There are the possibilities of an early pregnancy inside the uterus, a miscarriage or an ectopic pregnancy. The situation is clarified with a repeat ultrasound and blood tests at intervals.
Can an absolute assurance be given about ultrasound safety?
No. Although it is generally regarded as safe, the studies available have limits. It is recommended that exposure be kept as low as possible and that the examination last only as long as necessary.
Who plans the tests and check-ups after the ultrasound?
Your doctor assesses the findings together with your history and complaints. If there is uncertainty, the doctor may request a follow-up ultrasound or additional tests; the doctor also plans the timing and scope of later screening.
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