Patient Information What does the scan involve? In the first instance the scan is performed abdominally.
If the pregnancy cannot be clearly seen within the abdominal scan, then an internal scan can be very helpful (the internal scan is optional). This scan involves inserting a specially designed scan probe into the vagina which is then much closer to the uterus, tubes and ovaries than the abdominal scan. The scan doesn’t hurt and it cannot cause a miscarriage or any other problems.

When the scan has been performed, there are a number of possible outcomes. The pregnancy could be obviously viable with the fetal heartbeat clearly seen. No further scanning would be needed and the vast majority of pregnancies (at least 90%) will go on to be successful. We would give you your report and scan pictures and calculate a due date. However, it may not be clear from one scan what is happening. You may be advised to attend for a follow-up scan a week or two later to ensure the situation was clear before we can give you a definite outcome.

The finding of the scan and the interpretation would be discussed with you, and if a miscarriage appears to have occurred or if we are suspicious of an ectopic pregnancy, management can take several different styles, each of which has advantages and disadvantages. How is the Pregnancy dated? A pregnancy is dated from the first day of your last period. In a textbook pregnancy the conception will happen on day 14, so you are already 2 weeks pregnant when you conceive! The first missed period is on day 28 (4 weeks) and most people will do a pregnancy test at about 5-6 weeks.

Some people have pregnancy symptoms, which include tiredness and sickness, but many have no symptoms at all. The first signs of pregnancy on scan are at approximately 5 weeks, but it is not until 6 weeks that the fetal pole and the fetal heart are present. The traditional approach has been to date the pregnancy from the last period, but we can be more accurate with ultrasound scanning.

The ideal time to date a pregnancy is between 8 and 12 weeks by measuring the length of the baby (crown-rump length or CRL). There are some exceptions to the principle of dating by scan measurements, mostly surrounding other important information such as IVF or other certain dates. Early pregnancy problems Most pregnancies are normal, but some have problems. The most common problem is miscarriage or the much rarer problem of an ectopic pregnancy. If a woman has bleeding in early pregnancy, or abdominal pains it is helpful to have a scan. How do you know a pregnancy has miscarried? Most women will have vaginal bleeding, which prompts a scan, but sometimes the pregnancy will fail without giving any symptoms (this is called a missed miscarriage). The scan will show a pregnancy which is failing to develop normally. The key feature on an early pregnancy scan is to see the fetal heartbeat. If there is no pregnancy development to see within the uterus from 6 weeks gestation, the most likely reason is miscarriage but we also need to consider an ectopic pregnancy.

An ectopic pregnancy is where the pregnancy develops outside the uterus, usually in the fallopian tube. It is a potentially dangerous condition because it causes internal bleeding. It will usually present as vaginal bleeding and abdominal pain, but these symptoms are very variable. Anyone who has a positive pregnancy test, is more than 6 weeks from their last period and has no pregnancy seen on ultrasound scan within the uterus, may have an ectopic pregnancy. Sometimes the pregnancy can actually be seen outside the uterus (about 10% of cases) but often the pregnancy is not easy to see directly and we would rely on other signs (indications of bleeding inside the pelvis). If the situation is unclear, it may be helpful to do a blood pregnancy test which tells how much pregnancy hormone is being produced. This test is call a quantative HCG and can be undertaken at the same time as the ultrasound assessment, although the results will usually be available later the same day, or the following day.

If an ectopic pregnancy is suspected or seen for certain, the usual treatment would be to remove the pregnancy by keyhole surgery (laparoscopic salpingectomy). Other pregnancy related problems Another very rare problem is called hydatidiform mole. This is placental tissue with no fetal development. This problem can be suspected on scan but the true diagnosis rests on samples of the pregnancy tissue. The treatment for this type of pregnancy is a surgical evacuation of the uterus, and then follow-up with urine samples for about 6 months. Most people are fine after surgery, but sometimes the placental cells will remain active and produce pregnancy hormones. We would recommend that you do not get pregnant until the pregnancy hormones have been at low levels for 6 months.