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13-Nov-2017 16:18

With a transvaginal probe, a 2- to 3-mm gestational sac can usually be seen by 5 weeks from the last menstrual period (Fig 1A).

A yolk sac is usually seen by 6 menstrual weeks, or by the time the mean diameter of the sac has reached 10 mm (Fig 1B and Fig 1C).

Alternatively for international readers, the website,, of The International Society of Ultrasound in Obstetrics and Gynecology should be searched for similar guidelines.

Intrauterine sacs embryonic structures Warren and associates described the orderly appearance of gestational sac, yolk sac, and embryo with heartbeat at a given number of days from the onset of the last menstrual period (Table 1).

A fetal pole with heart tones is typically seen by the completion of 7 menstrual weeks (Fig 1D).

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).

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 β-h CG cut-offs for visualizing a intrauterine pregnancy sac, a yolk sac, and a fetus with heartbeat are guidelines.

My ultrasound today showed a 6 week embryo with a heartbeat (not sure how strong). but I know exactly how you feel I have had 2 miscarriages then I had my daughter she is one and just this august I had another miscarriage. I know when I ovulated and went in for my dating scan at what I thought was 7 weeks and 2 days. Idk date of conception but based on my last period at my first ultrasound I was suppose to be 6w5d Baby measured 6 weeks exactly with a heart beat of 124.

The practitioner must understand that these β-h CG levels are guidelines for the appearance of these structures and are not 100% reliable or accurate. Table 1 The appearance of early gestational structures LMP, last menstrual period; FHTs, positive fetal heart tones(Warren WB, Timor-Trisch I, Peisner DB et al: Dating the early pregnancy by sequential appearance of embryonic structures.

Am J Obstet Gynecol 17, 1989) Fig 1A A very early, 3-mm mean diameter intrauterine gestational sac at 5 weeks postmenstruation Fig 1B A typical yolk sac.

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.

Suffice it to say that the presently used Third International Standard and Fourth International Standard, used by most companies marketing β-h CG kits, corresponds roughly to the First International Reference Preparation.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.