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Early intrauterine pregnancy or decidual cast: an anatomic‐‐sonographic approach.

In order to differentiate an early intrauterine gestation from an ectopic pregnancy with decidual cast, demonstration of the uterine cavity as a structure distinct from the gestational sac is suggested. Anatomically, normal implantation occurs separately from the endometrial canal, whereas decidual casts form within the canal. Using real‐time sonography, physician observers were able to demonstrate two separate structures in 79 per cent of normal pregnancies of eight weeks' gestation or less when a special effort was made; routine longitudinal and transverse static and real‐time scans were less helpful.