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As shown by Fossum and colleagues, the appearance of these structures can be correlated with β-human chorionic gonadotropin (β-h CG) levels (Table 2).
The literature regarding the correlation between quantitative β-h CG titers and early intrauterine gestational sacs and embryonic structures has been made somewhat confusing by the array of reference standards used to quantify β-h CG.
These “pseudogestational sacs” can lead to a missed diagnosis of ectopic pregnancy (Figures 2A–2D).
Normal early gestational sacs are seen eccentrically placed in the decidua, adjacent to the echogenic central stripe (Figure 1A). A review of the literature by Richardson et al., from 2015, found the intradecidual sign was 66% sensitive and 100% specific in identifying an intrauterine pregnancy.
Intrauterine sacs embryonic structures Warren and associates described the orderly appearance of gestational sac, yolk sac, and embryo with heartbeat at a given number of days from the onset of the last menstrual period (Table 1).
The mean sac diameter of the gestational sac is 10.6 mm.The β-h CG cut-offs for visualizing a intrauterine pregnancy sac, a yolk sac, and a fetus with heartbeat are guidelines.These cut-offs are accurate in a high percentage of patients with singleton pregnancies, but are subject to biologic as well single test error.A yolk sac is usually seen by 6 menstrual weeks, or by the time the mean diameter of the sac has reached 10 mm (Fig 1B and Fig 1C).A fetal pole with heart tones is typically seen by the completion of 7 menstrual weeks (Fig 1D).
Today's obstetrician gynecologist is required to interpret and in many cases perform ultrasound scans in the first trimester.