Anembryonic pregnancy

Empty gestational sac without fetal pole. Need three views (length, width and height) to calculate MSD. An empty gestational sac with a MSD of ≥25 mm is diagnostic of an anembryonic pregnancy.  Early pregnancy loss occurs in approximately 10-20% of clinically recognized pregnancies

Anembryonic pregnancy
Ectopic pregnancy

Note that this gestational sac with fetal pole is not intrauterine (no cervix is seen in the same plane). Ectopic pregnancy occurs in approximately 1-2 % of pregnancies, and is even more uncommon among pregnant people seeking abortion (0.25%) (Duncan 2020).

Free Fluid in Cul-de-Sac

Longitudinal view of the uterus. Note the presence of anechoic (dark) fluid in the posterior cul-de-sac. This may be a finding consistent with blood from an ectopic pregnancy or uterine perforation


Gestational trophoblastic disease
(molar pregnancy)

Image of complete mole (no embryo). A complete mole generally has a cystic intrauterine mass with no distinct gestational sac with yolk sac or fetal pole. Often has a swiss cheese, snowstorm, or moth-eaten appearance on US. Consider referral for inpatient management > 12-week size  due to increased bleeding risk. Gestational trophoblastic disease occurs in approximately 0.1% of pregnancies


Gestational trophoblastic disease (molar pregnancy)

Fibroid uterus

Uterine fibroids are a common pelvic tumor that may enlarge or distort the cervix or uterine cavity, presenting technical difficulty. US can help identify the size, location, and orientation to the pregnancy



Images AIUM 2018 and 2020


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