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                                        First Trimester 6weeks+ 
			
				1
									 
													Heart
													pole
													trilaminar
													>18
													>7mm
													35
													be
													>4
											 
			
				
																	Visualization
																	 
																	of
																	 
																	the
																	 
																	embryo
																	 
																	on
																	 
																	ultrasound
																	 
																	is
																	 
																	often
																	 
																	referred
																	 
																	to
																	 
																	as
																	 
																	the
																	 
																	"
																	fetal
																	 
																		
												
																	"
																	 
																	and
																	 
																	should
																	 
																	be
																	 
																	seen
																	 
																	with
																	 
																	MSD
																	 
																		
												
																	 
																	mm
																	.
																	?
																	 
																	At
																	 
																	beginning
																	 
																	of
																	 
																	fifth
																	 
																	week
																	,
																	 
																	bilaminar
																	 
																	embryonic
																	 
																	disk
																	 
																	converts
																	 
																	into
																	 
																		
												
																	 
																	(
																	three
																	 
																	germ
																	 
																	layer
																	)
																	 
																	embryonic
																	 
																	disk
																	.
 ?
																	Organogenesis
																	 
																	begins
																	 
																	at
																	 
																	this
																	 
																	point
																	.
																	 
																	(
																	Organs
																	 
																	start
																	 
																	developing
																	)
 ?
																	 
																		
												
																	 
																	is
																	 
																	the
																	 
																	first
																	 
																	organ
																	 
																	to
																	 
																	function
																	 
																	within
																	 
																	embryo
 o
																	 
																	Starts
																	 
																	beating
																	 
																	at
																	 
																	approximately
																	 
																		
												
																	 
																	days
																	 
																	(
																	5
																	 
																	to
																	 
																	5½
																	 
																	weeks
																	)
 o
																	 
																	Embryonic
																	 
																	heartbeat
																	 
																	must
																	 
																		
												
																	 
																	seen
																	 
																	in
																	 
																	living
																	 
																	embryo
																	 
																	when
																	 
																	CRL
																	 
																		
												
																	 
																	mm
																	.
																	 
																		
												
																	 
																	with
																	 
																	no
																	 
																	heartbeat
																	 
																	is
																	 
																	considered
																	 
																	nonviable
																	.
 
 
			
				2
									 
													5
													Ectoderm
													Endoderm
													Mesoderm
											 
			
				
																	3
																	 
																	primitive
																	 
																	germ
																	 
																	cell
																	 
																	layers
																	 
																	that
																	 
																	compromise
																	 
																	embryonic
																	 
																	disk
																	 
																	by
																	 
																		
												
																	-
																	week
																	 
																	past
																	 
																	LMP
																	 
																	o
																	 
																		
												
																	:
																	 
																	inner
																	 
																	layer
																	-
																	 
																	becomes
																	 
																	GI
																	 
																	&
																	 
																	respiratory
																	 
																	systems
 o
																	 
																		
												
																	:
																	 
																	middle
																	 
																	layer
																	 
																	?
																	 
																	becomes
																	 
																	musculoskeletal
																	 
																	&
																	 
																	circulatory
																	 
																	systems
 o
																	 
																		
												
																	:
																	 
																	outer
																	 
																	layer
																	 
																	?
																	 
																	becomes
																	 
																	brain
																	 
																	&
																	 
																	nervous
																	 
																	system
																	,
																	 
																	and
																	 
																	ski
																	n
 
			
				3
									 
													umbilical
													allantois
													Allantois
													sixth
													Omphalomesenteric
													gastrointestinal
													allantoic
													Vitelline
													trilaminar
													2
													constriction
											 
			
				
																	At
																	 
																	beginning
																	 
																	of
																	 
																		
												
																	 
																	week
																	 
																	of
																	 
																	gestation
																	,
																	 
																		
												
																	 
																	embryonic
																	 
																	disk
																	 
																	folds
																	 
																	into
																	 
																	Cshaped
																	 
																	embryo
																	.
																	 
																	o
																	 
																	While
																	 
																	embryonic
																	 
																	folding
																	 
																	continues
																	,
																	 
																	this
																	 
																	results
																	 
																	in
																	 
																	a
																	 
																		
												
																	 
																	or
																	 
																	narrowing
																	 
																	between
																	 
																	embryo
																	 
																	and
																	 
																	yolk
																	 
																	sac
																	,
																	 
																	creating
																	 
																	the
																	 
																	yolk
																	 
																	stalk
 ?
																	 
																	The
																	 
																	yolk
																	 
																	stalk
																	 
																	consists
																	 
																	of
																	 
																		
												
																	 
																	ducts
																	:
 ?
																	 
																		
												
																	/
																	 
																		
												
																	 
																	duct
																	:
																	 
																	part
																	 
																	of
																	 
																	the
																	 
																	connecting
																	 
																	stalk
																	 
																	of
																	 
																	the
																	 
																	embryo
																	 
																	that
																	 
																	gives
																	 
																	rise
																	 
																	to
																	 
																	part
																	 
																	of
																	 
																	the
																	 
																	umbilical
																	 
																	cord
																	 
																	and
																	 
																	bladder
																	.
																	 
																	Obliterates
																	 
																	to
																	 
																	form
																	 
																	the
																	 
																	urachus
																	.
 ?
																	 
																		
												
																	 
																	duct
																	 
																	/
																	 
																		
												
																	 
																	duct
																	:
																	 
																	During
																	 
																	embryonic
																	 
																	folding
																	,
																	 
																	the
																	 
																	dorsal
																	 
																	aspect
																	 
																	of
																	 
																	yolk
																	 
																	sac
																	 
																	(
																	vitelline
																	 
																	duct
																	)
																	 
																	is
																	 
																	incorporated
																	 
																	into
																	 
																	the
																	 
																	embryo
																	,
																	 
																	developing
																	 
																	the
																	 
																	foregut
																	,
																	 
																	midgut
																	,
																	 
																	hindgut
																	,
																	 
																	and
																	 
																	forming
																	 
																	the
																	 
																	entire
																	 
																		
												
																	 
																	tract
																	,
																	 
																	liver
																	,
																	 
																	biliary
																	 
																	tract
																	,
																	 
																	and
																	 
																	pancreas
 o
																	 
																	The
																	 
																	yolk
																	 
																	stalk
																	 
																	and
																	 
																		
												
																	 
																	are
																	 
																	brought
																	 
																	together
																	 
																	by
																	 
																	expanding
																	 
																	amnion
																	,
																	 
																	which
																	 
																	covers
																	 
																	the
																	 
																	three
																	 
																	structures
																	 
																	forming
																	 
																	the
																	 
																		
												
																	 
																	cord
																	.
 
			
				4
									 
													Rhombencephalon
													ectoderm
													metencephalon
													Dandy
													cystic
													8
													Prosencephalon
													Cystic
													parallel
													myelencephalon
											 
			
				
																	From
																	 
																	6
																	 
																	to
																	 
																	10
																	 
																	Weeks
																	:
																	?
																	 
																	Spine
																	 
																	develops
																	 
																	from
 o
																	 
																	May
																	 
																	be
																	 
																	visualized
																	 
																	sonographically
																	 
																	as
																	 
																		
												
																	 
																	echogenic
																	 
																	lines
																	 
																	at
																	 
																	6
																	 
																	weeks
																	 
																	of
																	 
																	gestation
																	.
 ?
																	 
																	Cranium
																	 
																	undergoes
																	 
																	dramatic
																	 
																	changes
																	 
																	from
																	 
																	sixth
																	 
																	to
																	 
																	10th
																	 
																	week
																	 
																	of
																	 
																	gestation
 o
																	 
																	By
																	 
																		
												
																	 
																	weeks
																	,
																	 
																	3
																	 
																	vesicles
																	 
																	seen
																	 
																	within
																	 
																	fetal
																	 
																	brain
																	:
 ?
 ?
																	 
																	Mesencephalon
 ?
																	 
																		
												
																	 
																	-
																	 
																	Divides
																	 
																	into
																	 
																	two
																	 
																	segments
																	:
 ?
																	 
																	Cephalic
																	 
																	portion
																	:
																	 
																		
												
																	 
																	which
																	 
																	forms
																	 
																	cerebellum
																	 
																	and
																	 
																	pons
 ?
																	 
																	Caudal
																	 
																	component
																	:
																	 
																		
												
																	 
																	which
																	 
																	forms
																	 
																	the
																	 
																	medulla
 o
																	 
																	Once
																	 
																	rhombencephalon
																	 
																	divides
																	,
																	 
																	the
																	 
																	cystic
																	 
																	rhomboid
																	 
																	fossa
																	 
																	forms
																	:
																	 
																	a
																	 
																		
												
																	 
																	structure
																	,
																	 
																	seen
																	 
																	within
																	 
																	posterior
																	 
																	aspect
																	 
																	of
																	 
																	embryonic
																	 
																	cranium
 ?
																	 
																	This
																	 
																	should
																	 
																	not
																	 
																	be
																	 
																	confused
																	 
																	with
																	 
																	pathology
																	,
																	 
																	such
																	 
																	as
																	 
																		
												
																	-
																	Walker
																	 
																	malformation
																	.
 ?
																	 
																		
												
																	 
																	rhomboid
																	 
																	fossa
																	 
																	can
																	 
																	routinely
																	 
																	be
																	 
																	imaged
																	 
																	sonographically
																	 
																	from
 eighth
																	 
																	to
																	 
																	10th
																	 
																	week
																	 
																	of
																	 
																	gestation
																	.
 
			
				5
									 
													CSF
													medulla
													fossa
													10
													falx
											 
			
				
																	By
																	 
																	9
																	 
																	weeks
																	 
																	the
																	 
																	midline
																	 
																		
												
																	 
																	is
																	 
																	formed
																	 
																	and
																	 
																	the
																	 
																	echogenic
																	 
																	choroid
																	 
																	plexus
																	 
																	tissue
																	 
																	seen
																	 
																	this
																	 
																	produces
																	 
																		
												
																	.
																	 
																	The
																	 
																	lateral
																	 
																	ventricles
																	 
																	completely
																	 
																	fill
																	 
																	cerebral
																	 
																	vault
																	?
																	 
																	At
																	 
																		
												
																	 
																	weeks
																	 
																	further
																	 
																	evolution
																	 
																	of
																	 
																	cerebellum
																	,
																	 
																		
												
																	,
																	 
																	and
																	 
																	medulla
																	 
																	oblongata
																	 
																	encloses
																	 
																	rhomboid
																	 
																		
												
																	 
																	to
																	 
																	form
																	 
																	primitive
																	 
																	fourth
																	 
																	ventricle
																	 
																	and
																	 
																	part
																	 
																	of
																	 
																	cerebral
																	 
																	aqueduct
																	 
																	of
																	 
																	Sylvius
																	.
 ?
																	 
																	Cerebellum
																	 
																	is
																	 
																	fused
																	 
																	and
																	 
																	brain
																	 
																	structure
																	 
																	complete
																	 
																	shortly
																	 
																	thereafter
 
 
			
				6
									 
													seventh
													bony
													tail
													neural
													transvaginal
													calcification
													clavicle
													10th
													cranial
											 
			
				
																	More
																	 
																	6
																	-
																	10
																	 
																	weeks
																	 
																	changes
																	:
																	o
																	 
																	Limb
																	 
																	buds
																	 
																	and
																	 
																	embryonic
																	 
																		
												
																	 
																	are
																	 
																	recognizable
																	 
																	during
																	 
																	sixth
																	 
																	week
																	 
																	of
																	 
																	gestation
 o
																	 
																	Sonographically
																	,
																	 
																	limb
																	 
																	buds
																	 
																	may
																	 
																	be
																	 
																	detected
																	 
																	from
																	 
																		
												
																	 
																	week
																	 
																	on
																	.
 o
																	 
																	Hands
																	 
																	and
																	 
																	feet
																	 
																	develop
																	 
																	later
																	 
																	in
																	 
																	first
																	 
																	trimester
																	 
																	and
																	 
																	completely
																	 
																	formed
																	 
																	by
																	 
																	end
																	 
																	of
																	 
																		
												
																	 
																	week
																	 
																	of
																	 
																	gestation
 o
																	 
																	Fingers
																	 
																	and
																	 
																	toes
																	 
																	have
																	 
																	been
																	 
																	identified
																	 
																	using
																	 
																		
												
																	 
																	sonography
																	 
																	at
																	 
																	10
																	 
																	weeks
 o
																	 
																	Limbs
																	 
																	not
																	 
																	routinely
																	 
																	identified
																	 
																	until
																	 
																		
												
																	 
																	of
																	 
																	long
																	 
																	bones
																	 
																	begins
																	 
																	at
																	 
																	10
																	 
																	weeks
 o
																	 
																	8
																	 
																	weeks
																	-
																	 
																	Calcification
																	 
																	of
																	 
																		
												
																	 
																	begins
																	,
																	 
																	followed
																	 
																	by
																	 
																	ossification
																	 
																	of
																	 
																	mandible
																	,
																	 
																	palate
																	,
																	 
																	vertebral
																	 
																	column
																	,
																	 
																		
												
																	 
																	arches
 o
																	 
																	9
																	 
																	weeks
																	-
																	 
																	Frontal
																	 
																		
												
																	 
																	bones
																	 
																	begin
																	 
																	to
																	 
																	calcify
																	 
																	followed
																	 
																	by
																	 
																	long
																	 
																	bones
 o
																	 
																	10
																	 
																	weeks
																	-
																	 
																	Further
																	 
																		
												
																	 
																	palate
																	 
																	development
																	 
																	may
																	 
																	be
																	 
																	visualized
 
 
			
				7
									 
													gastroschisi
													elongates
													Midgut
													10
													external
													12
													omphalocele
													primitive
													6
													echogenic
											 
			
				
																	Anterior
																	 
																	abdominal
																	 
																	wall
																	 
																	is
																	 
																	developed
																	 
																	by
																	 
																		
												
																	 
																	weeks
																	 
																	gestation
																	 
																	o
																	 
																	The
																	 
																		
												
																	 
																	gut
																	 
																	is
																	 
																	formed
																	 
																	simultaneously
																	 
																	as
																	 
																	the
																	 
																	dorsal
																	 
																	yolk
																	 
																	sac
																	 
																	is
																	 
																	incorporated
																	 
																	into
																	 
																	the
																	 
																	embryo
																	.
																	 
																	It
																	 
																	then
																	 
																	develops
																	 
																	into
																	 
																	the
																	 
																	midgut
																	.
 o
																	 
																		
												
																	 
																	forms
																	 
																	the
																	 
																	majority
																	 
																	of
																	 
																	small
																	 
																	bowel
																	,
																	 
																	cecum
																	,
																	 
																	ascending
																	 
																	colon
																	,
																	 
																	proximal
																	 
																	transverse
																	 
																	colon
 o
																	 
																	As
																	 
																	amniotic
																	 
																	expansion
																	 
																	occurs
																	,
																	 
																	midgut
																	 
																		
												
																	 
																	faster
																	 
																	than
																	 
																	embryo
																	,
																	 
																	causing
																	 
																	midgut
																	 
																	to
																	 
																	herniate
																	 
																	into
																	 
																	the
																	 
																	base
																	 
																	of
																	 
																	umbilical
																	 
																	cord
 o
																	 
																	So
																	 
																	because
																	 
																	there
																	?
																	s
																	 
																	not
																	 
																	enough
																	 
																	room
																	 
																	in
																	 
																	the
																	 
																	abdomen
																	 
																	for
																	 
																	the
																	 
																	midgut
																	 
																	(
																	bowel
																	)
																	 
																	to
																	 
																	grow
																	 
																	at
																	 
																	it
																	?
																	s
																	 
																	normal
																	 
																	rate
																	,
																	 
																	it
																	 
																	grows
																	 
																	and
																	 
																	develops
																	 
																		
												
																	 
																	to
																	 
																	the
																	 
																	fetal
																	 
																	abdomen
																	 
																	and
																	 
																	then
																	 
																	migrates
																	 
																	back
																	 
																	in
																	 
																	when
																	 
																	there
																	?
																	s
																	 
																	enough
																	 
																	space
																	.
 ?
																	 
																	This
																	 
																	transition
																	 
																	of
																	 
																	bowel
																	 
																	can
																	 
																	readily
																	 
																	be
																	 
																	visualized
																	 
																	as
																	 
																	an
																	 
																		
												
																	 
																	mass
																	 
																	within
																	 
																	base
																	 
																	of
																	 
																	umbilical
																	 
																	cord
																	.
 o
																	 
																	Until
																	 
																		
												
																	 
																	weeks
																	 
																	of
																	 
																	gestation
																	,
																	 
																	midgut
																	 
																	loop
																	 
																	continues
																	 
																	to
																	 
																	grow
																	 
																	and
																	 
																	rotate
																	 
																	before
																	 
																	it
																	 
																	descends
																	 
																	into
																	 
																	fetal
																	 
																	abdomen
																	 
																	at
																	 
																	about
																	 
																	the
																	 
																	11th
																	 
																	week
																	.
 o
																	 
																	After
																	 
																		
												
																	 
																	weeks
																	 
																	of
																	 
																	gestation
																	,
																	 
																	this
																	 
																	echogenic
																	 
																	umbilical
																	 
																	cord
																	 
																	mass
																	 
																	is
																	 
																	no
																	 
																	longer
																	 
																	visualized
																	 
																	and
																	 
																	echogenic
																	 
																	bowel
																	 
																	is
																	 
																	now
																	 
																	seen
																	 
																	within
																	 
																	fetal
																	 
																	abdomen
 o
																	 
																	It
																	 
																	is
																	 
																	important
																	 
																	that
																	 
																	this
																	 
																	normal
																	 
																	embryologic
																	 
																	event
																	 
																	not
																	 
																	be
																	 
																	confused
																	 
																	with
																	 
																	pathologic
																	 
																	processes
																	,
																	 
																	such
																	 
																	as
																	 
																		
												
																	 
																	or
 
			
				8
									 
													100
													eighth
													90
													140
													maternal
											 
			
				
																	?
																	By
																	 
																	end
																	 
																	of
																	 
																		
												
																	 
																	week
																	 
																	of
																	 
																	gestation
																	,
																	 
																	heart
																	 
																	has
																	 
																	obtained
																	 
																	its
																	 
																	adult
																	 
																	configuration
																	.
																	o
																	 
																	Embryonic
																	 
																	cardiac
																	 
																	rates
																	 
																	vary
																	 
																	with
																	 
																	gestational
																	 
																	age
																	.
																	 
																		
												
																	 
																	to
																	 
																	115
																	 
																	bpm
																	 
																	at
																	 
																	6
																	 
																	weeks
																	,
																	 
																		
												
																	 
																	to
																	 
																	160
																	 
																	bpm
																	 
																	at
																	 
																	9
																	 
																	weeks
																	.
 o
																	 
																	Documenting
																	 
																	fetal
																	 
																	heartbeat
																	 
																	of
																	 
																	over
																	 
																		
												
																	 
																	bpm
																	 
																	provides
																	 
																	discrimination
																	 
																	from
																	 
																	maternal
																	 
																	heartbeat
																	.
 ?
																	 
																	If
																	 
																	unsure
																	 
																	of
																	 
																	maternal
																	 
																	vs
																	 
																	fetal
																	 
																	heart
																	 
																	rate
																	,
																	 
																	or
																	 
																	is
																	 
																	fetal
																	 
																	heart
																	 
																	rate
																	 
																	is
																	 
																	low
																	,
																	 
																	obtain
																	 
																	and
																	 
																	document
																	 
																		
												
																	 
																	puls
																	e
 
			
				9
									 
													bleb
													16
													placenta
													5½
													chorioamniotic
											 
			
				
																	?
																	 
																	Transvaginally
																	,
																	 
																	the
																	 
																	amniotic
																	 
																	membrane
																	 
																	that
																	 
																	separates
																	 
																	the
																	 
																	amniotic
																	 
																	cavity
																	 
																	and
																	 
																	chorionic
																	 
																	cavity
																	 
																	is
																	 
																	routinely
																	 
																	seen
																	 
																	after
																	 
																		
												
																	 
																	weeks
																	 
																	?
																	 
																	"
																	double
																	 
																		
												
																	 
																	sign
																	"
																	-
																	 
																	simultaneous
																	 
																	side
																	 
																	by
																	 
																	side
																	 
																	appearance
																	 
																	of
																	 
																	amnion
																	 
																	and
																	 
																	yolk
																	 
																	sac
 o
																	 
																	Gradually
																	,
																	 
																	the
																	 
																		
												
																	 
																	takes
																	 
																	over
																	 
																	process
																	 
																	of
																	 
																	waste
																	 
																	removal
																	,
																	 
																	amniotic
																	 
																	cavity
																	 
																	expands
																	,
																	 
																	and
																	 
																	chorionic
																	 
																	cavity
																	 
																	decreases
																	 
																	in
																	 
																	size
																	.
 ?
																	 
																	Fusion
																	 
																	of
																	 
																	membranes
																	 
																	(
																		
												
																	 
																	fusion
																	)
																	 
																	occurs
																	 
																	at
																	 
																	approximately
																	 
																	14
																	 
																	to
																	 
																	15
																	 
																	weeks
																	 
																	and
																	 
																	should
																	 
																	be
																	 
																	complete
																	 
																	by
																	 
																		
												
																	 
																	week
																	s
 |