Early 1st Trimester

• Both transabdominal and transvaginal approaches should be used prior to 9 weeks.

• Obtain uterine measurements in sagittal and transverse planes transabdominally.

o Uterine length and height taken in sagittal plane, width taken in transverse plane.

• Note uterine contour and measure and document location any fibroids with images and in report.

• Note the presence or absence of free fluid in the cul-de-sac.

• Image bilateral adnexa.

• Identify and measure each ovary length, height and width.

o Document and measure any cysts and/or masses present. Note appearance of cyst/mass on report. Color flow Doppler can be used on cysts/masses only.

• Identify the gestational sac and note location in the uterus.

• Identify the embryo or fetal pole and number present.

o If pole is not visible, measure the gestational sac in 3 largest planes for gestational age by Mean Sac Diameter.

• Obtain CRL measurements x3 (minimum) in longest plane of pole/embryo.

• Document FHR using M-mode Doppler only. A minimum of 3-5 Doppler cycles should be obtained.

o Do not use color flow Doppler on fetus unless confirming demise

o If unable to measure FHR with M-mode due to early gestation, document in report.

• Identify and measure the yolk sac in AP view. (inner to inner)

• Complete ultrasound report, including any abnormal findings and scheduled follow up.

o If no fetal pole is visualized make sure to change fetal count to 0 on AS report.