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Their finding is very useful in differentiating early pregnancy sacs from intracavitary fluid.Our lab at Northwestern relies very heavily on the intradecidual sign and the appearance of the sac on the sagittal view to differentiate very early pregnancy sacs from pseudosacs.Today's obstetrician gynecologist is required to interpret and in many cases perform ultrasound scans in the first trimester.In fact, certification of residency programs in many countries requires documentation of adequate exposure to and training in the evaluation of first-trimester ultrasound.

Fig 2A An eccentrically placed intrauterine gestational sac 6 weeks postmenstruation (arrow) Fig 2B In contrast, a pseudosac (arrow) in a patient with ectopic pregnancy representing a collection of blood or fluid collected within the endometrial cavity.For United States readers, the website, aium.org, of the American Institute of Ultrasound in Medicine will be helpful for guidelines.Alternatively for international readers, the website, isuog.org, of The International Society of Ultrasound in Obstetrics and Gynecology should be searched for similar guidelines.Any health-care provider performing diagnostic ultrasound must understand the physics of diagnostic ultrasound and have thorough, supervised training.This includes, but is not limited to, power settings, basic orientation, and proper cleaning of ultrasound probes between uses.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.Fertil Steril 8, 1988) Discriminatory zones The generally accepted β-h CG discriminatory zone of 2000m IU/ml for the appearance of an intrauterine gestational sac is not 100% reliable.Recent papers by Doubilet and Benson and Ko and Cheung have provided examples of women with titers greater than 2000 m IU/ml, where transvaginal ultrasound did not identify a early intrauterine sac, and a subsequent ultrasound confirmed a viable pregnancy.The double decidual ring sign was 82% sensitive and 97% specific.Confidence intervals for the reviewed studies were not ideal because of the size of the studies. using high resolution ultrasound found a diagnostic sensitivity of 94% and 100% specificity for the double decidual ring in identifying an intrauterine pregnancy.The length and the anterior-posterior dimensions of the gestational sac are measured on this sagittal image of this retroverted uterus Fig 1C The third diameter of the gestational sac seen in Figure 1B is measured in this image.The mean sac diameter is the average of the three measured diameters (dimensions) of the sac Fig 1D A early 7 mm fetal pole corresponding to 6 weeks 4 days menstrual weeks Table 2 Correlation between β-human chorionic gonadotropin (β-h CG) levels and appearance of early gestational structures LMP, last menstrual period; IRP, International Reference Preparation; IS, International Standard(Fossum GT, Davajan V, Kletzky OA: Early detection of pregnancy with transvaginal ultrasound.The disadvantages of performing this examination routinely are related to cost, errors in diagnosing ectopic pregnancies that in fact are intrauterine, increased training requirements for providers, and potential biologic hazards to the fetus that are presently unknown.The potential benefits of a subsequent ultrasound examination at 12–14 weeks from the LMP include: Similarly the standard of care for performing routine ultrasound at 12–14 weeks' gestation from the LMP varies from country to country.

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