Sonoembryology-The speed of growth of fertilized Ova ?

There is an increased risk of congenital abnormalities . In the CEMACH  study of pre-existing diabetes the overall rate was 4% with a three fold increase in the ,,rates of both neural tube defects and congenital heart disease time of conception and directly correlated with the Hba1c . Women with HbA1c <8% have a risk of approximately 5 % but in those with levels >10 % the risk is as high as 25%. The risk is eliminate if normal HbA1c levels are achieved. The recommendation is that the HbA1c should be <7% and <6.1% in the United Kingdom if safely achievable at the time of conception.

The specific congenital abnormality associated with diabetes is sacral agenesis , but this is very rare. Much more common are congenital heart defects skeletal abnormalities and neural tube defects.

The perinatal and neonatal mortality rates can be increased 5 to 10 fold in babies of mothers with diabetes and these too relate to HbA1c at conception and in early pregnancy . In the CEMACH study of diabetes in pregnancy in the United Kingdom the perinatal mortality rate for both type 1 and type 2 diabetes was about 3 %.

 

 

SONO- EMBROYOLOTY CHART

Date                         Event

Day 14                    Ovulation                  Collapse of Follicle ,Free                                                                                                          Fluid                                     Day15                  Fertilization                  corpus luteum Secretory                                                                         endometrium       Day 18           Morula stage                    Decidualization of                                                                    Endometrium Day22-23      Blastocyst                       Implantation window   Day 23         Primary Yolk sac             Implantation site   Day26-28   Extra Embryonic            implantation site recognition   Day27-28 Secondly Yolk sac   Day28    Syncytiotrphoblast                And sometimes seen Chorionic cavity     Week 5 Gastrulation                           Visualization of Gestational                                                                 Sac and secondary. Yolk sac 29/30 31/42      Neuralisation                         Growth of sac   34/44       Sometimes                            Embryo  fetal cardiac                                                                          Activity                                                               Embryo visualization                                                              Crown rump length Cardiac activity   Week6-12                Cardiovascular                                  System 6 Weeks                    Unidirectional                  Cardiac activity                                  Blood flow 8 Weeks                  Heart/                                  Seen by TVS  10 Weeks                Peripheral vascular               Visualized                                   System

 

 

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 Speed og growth of fertilized ovum??  What are the sequential changes in Fertilized Oocyte (later) embryo and endometrium (later decidua) ??

May rely more on sequential TVS and avoiding any special medication .A quick recapitulation to diagnose if speed of growth of embryo is normal-by sequential USG. Also such sonography is sometimes termed as Viability Scan. One can assess the gest age accurately if such a sonography is carried out by 6-7 weeks with absolute accuracy. The usual sequential appearance of sonological findings related to appearance of gestation age are as follows: -Sometimes called sono-embrylogy: -

1)              First sonological sign = hyperechoic endometrium

2)               What is the orderly appearance of second and third signs to appear in normal pregnancies?-The second sign after echogenic bright endo is appearance of GS (gestational Sac)- if sac is seen Duration of pregnancy should be 4.5 weeks(TVS). May try to exclude pseudo-sac of ectopic gestation

3)              Third sign in a normally growing embryo-is appearance of yolk sac inside the gest sac+ 5 wks. (by TVS)/ 6 weeks by Abd route(TAS).

4)               Q.7. What are the other signs to follow? Embryo visible= 5.5. weeks, ,6-6.5 weeks in TAS.

5)              Cardiac Activity-Flickering to initiate with at 5.4 weeks(TVS) / 6.5 by TAS.

 

6)               Unless beta HCG is > 1500 IU it will be impossible to view the sac. Hopefully,the sac will appear after 1-2 weeks time. AS because coupe don't like to have pregnancy therefore may suggest for 1 dose of MTX 50 mg IM ,provided her Heamogram, leukocyte cunt in articular ,are normal. This will hopefully end the matter. May follow up with UPT only. Later may counsel for COC if no contraindications. may view your message column. for details of sono-embryology-appearance of chronological appearance of of C changes, SAC appearances, Foetal poles-details , FHR etc in relation to Chronology of beta HCG in relation to GSD & CRL, Menst age & Ovulation in particular.

7)              Worried about discordant HCG level in relation to GSD?? . one  may  repeat TVS after 2 weeks to confirm whether embryo is appearing or not (visible yolk  sac / F pole) --growing as per norms or not. HCG titer may, vary because all placenta don’t synthesize identical amount of HCG and more importantly there are several errors in estimation of beta-HCG including “phantom HCG” and similarities with alpha-subunits. AS such there are always a range stated per GSD. (percentile). Too much reliance may not be fair Better may insist on follow up scan to note appearance of Y sac-its diameter,  embryo, and later growth of embryo. AS things stand now much more relevant is to exclude   EP. (by Rpt HCG after 3 days & serum Progesterone)