 Hello everyone, myself Dr. Svetlana Sengen-Inje, third year junior resident of department of radio diagnosis, VDGMC Latur. I'm presenting a paper on sonological evaluation in first-time master PV bleeding with co-author Dr. Balaji Kumde and Dr. Arthich Kumvatsar. My aims and objectives are sonological evaluation of cleanly suspected first-time master PV bleeding to prognosticate and predict the status of abnormal pregnancy to evaluate the uterine structural defects which leads to repeated abortions. Introduction for general PV bleeding in the first-time master pregnancy is the common obstetric problem and cause of anxiety and worry both to the patient and obstetrician. The common causes of bleeding during first-time master include various types of abortions, ectopic pregnancy and molar pregnancy. Ultrasome both transvergenin and transabdominus plays an important role in the evolution of the causes of first-time master bleeding, prognosticate and predict the status of abnormal pregnancy. Normal first-time master sonography shows G-sac which is visible by transvergenin ultrasound by four and a half weeks. It is determined by calculating venous sac diameter and by showing peritropoplastic flow. It shows characteristic double-decidive sign which is formed by decidor capsularis and decidor paratylis. It is visible by five and a half weeks by TVS and TAS shows it by seven weeks. It is spherical in shape and with a well-defined ectogenic periphery and sonolucent center it confirms early uterine pregnancy. Embryo and cardiac activity, TVS is able to detect embryo which is singing of yolk sac margin. The CRL is 2-3mm. At six weeks when the CRL is 5mm it should be seen by TVS as a separate structure from the yolk sac and cardiac pulsations should be visible. Means and diameter. The G-sac is seen at five weeks by transabdominus while long. It is seen as early as four weeks by TVS. Three measurements should be taken, length, depth and width and it should be divided by three. CRL that is crown lump length. It is the greatest fetal dimension obtained by scanning till maximum length of fetal node is seen. Names are excluded. BPD by parameter diameter is the parameter used to determine gestational age. It becomes more accurate than CR. This image shows normal first-time master drug sonography, umbilical cord, amnion, embryo, yolk sac, fetal length and placent. Courses of first-time master bleeding. Abortions like threatened, missed, complete, incomplete, inevitable, blighted ovum, atopic pregnancy, vesicular mould and others include submucosal fibroids. Abortions. It is the expression of products before 28 weeks of gestation. It can be threatened which shows empty uterus or intrauterine g-sac with or without embryo. Complete abortion shows empty uterus. Incomplete abortion shows electrodes or residual propoblastic tissue in the endometal cavity. Missed abortion shows an intrauterine embryo without cardiac activity. The embryo can be small for gestation age and are disproportionate. Recurrent abortion. The sonographic findings depend on the stage of gestation and type of abortion. Sonographic findings are thick and irregular endometal lining with fluid in the endometal cavity. Inhabitable abortion. It shows an echoing area which is seen surrounding around the gestational sac where the sac is dissected away from the uterine wall. The sac is seen lying low in the uterus and the cervical canal is dilated. This sonographic image shows the echoing contents in the endometal cavity, suggestive of incomplete abortion or written products of conception. This image shows the echoing contents in the endometal cavity with no cardiac activity, suggestive of missed abortion or written products of conception. Sub-coreanic hemorrhage. It is partial retachment of propoblast from the uterine wall or abruption of the placental margin. The uterine wall disappears as the placental margin which is riskless by anecdotal or heterogeneous hybrid material. Small echogenic structures can be found due to clots and hematoma may be visualized. It usually gets resolved. Sub-coreanic hemorrhage. This you can see here. Molar pregnancy. It can be complete or incomplete. The classic sonographic features of complete molar pregnancy include an enlarged uterus with central heterogeneous echogenic mass that expands the endometal cavity which contains multiple cystic spaces operating size from few millilitres to two to three centimetres, representing hydrophic villa. In complete mode, a fetus is upset. Partial molar pregnancy shows overlap with other conditions such as an hemorrhonic pregnancy or an incomplete abortion. In partial molar pregnancy, the placental is exclusive in size and contains numerous cystic spaces distributed in non-uniform manner. This trans-abdominal sonography reveals complex echogenic mass containing small irregular cysts which are surrounded by fluid collection in the endometal cavity. It suggests a complete molar pregnancy. Ectopic pregnancy. It should be suspected in patients who present with positive pregnancy days with an absence of endometal intrauterine pregnancy or ultrasound. The most common location is palopentium. Others are ovary, abdomen, cervix and uterine scars. Fluid can be seen in the endometal cavity termed as pseudocyte. An embryonic pregnancy that is lighted ovum. It refers to gestational slag in which embryo either failed to develop or died at the early stage of pregnancy to visualize. Sonographically, it is characterized by large empty slag measuring 12 to 89. This trans-abdominal sonogram showing tight etymical mass in patients who are presenting with PV bleeding, showing a bit colored ovular, showing cystic, thick walled mass with ring-of-fine sign that is ectopic pregnancy. This image shows empty gestational slag, which is at 10 weeks with absent yoke slag and fetal lobes, suggesting an embryonic gestation. This image shows submucous fiber lying in the endometal cavity. Mertigens and methods, data for the study was collected from pregnant women, referred to VDGEMC LATU, Radioagnosis Department. Study design was a prospective cross-sectional study. It was done on Geologic Q, P9 ultrasound system. In VDGEMC LATU, 50 patients were screened and simple random sampling procedure was done. Results. A study group aged 18 to 35 years. There is significant disparity between the clinical diagnosis and spinal diagnosis whereas ultrasound diagnosis has brought greater reliability. There is 100% sensitivity of ultrasound diagnosis in all cases except for ectopic gestation, which is 80%. We have divided our group studies into three main categories for the purpose of statistical correlation. The three groups are viable, intravitant pregnancy, non-viable, intravitant pregnancy and ectopic pregnancy. It was formed on the basis of subsequent life of management in particular cases. All cases of viable, intravitant pregnancy were followed up, followed to be up without intervention while other cases were managed as they have prepared based on ultrasound findings. This is comparison of clinical ultrasound and spinal diagnosis in tabulated form. Follow-up of sonologically diagnosed cases out of 18 cases of threatened abortion. 12 cases continued to normal term gestation while 6 were present with miscarriage. On repeat ultrasound, out of these 6 cases, 2 were in missed abortion, 2 incomplete abortion and 2 cases with complete spontaneous abortion. All 4 cases of ectopic gestation were currently diagnosed with ultrasound. Of the 6 cases, sonologically diagnosed complete abortion. Only 5 were correctly diagnosed whereas 1 ectopic gestation was best diagnosed as complete abortion. 10 cases of incomplete abortion, 4 cases of inevitable abortion and 4 cases of missed abortion. 2 cases of hydratiform bone and 2 cases of anembryonic gestation were all correctly diagnosed with ultrasound. This was followed up to study cases diagnosed with ultrasound, which shows in tabulated discussions, normal pregnancy with excellent changes for a viable birth could be differentiated using ultrasound from a pathological pregnancy which prevents an immediate termination. The sonographic landmarks for the first time in the state of pregnancy include identification of G-stack, fetal pool, fetal cardiac activity movements, yolk sag and ammonia. Ultrasome, both T-V-S and T-S plays an important role in the evolution of causes of first time pregnancy. Real-time sonography is a non-invasive modality that is extremely useful to arrive at accurate diagnosis. In our study, we compared our study with the Jardim Malhotra study and Reddy Rani study which is as described in this tabulated form. It was also compared with Ramasopat and Neelam study. I express my sincere gratitude to all faculty members including Dr. Balaji Kombadso and Dr. Adish Kombadso for their assistance. These were the books and publications from where the data was collected. With this, I conclude my stoppage. Thank you.