“Failed early pregnancy” From Radiopaedia

In this post, I link to and excerpt from Radiopaedia‘s Failed early pregnancy. Last revised by Dr Yuranga Weerakkody◉ on 05 Mar 2022.

All that follows is from the above resource:

Failed early pregnancy (sometimes termed embryonic demise) refers to the death of the embryo and therefore, miscarriage. The most common cause of embryonic death is a chromosomal abnormality.

  • crown-rump length (CRL) of ≥7 mm and no heartbeat on a transvaginal scan 3
  • mean sac diameter (MSD) of ≥25 mm and no embryo on a transvaginal scan 3
  • absence of embryo with heartbeat ≥2 weeks after a scan that showed a gestational sac without a yolk sac
  • absence of embryo with heartbeat ≥11 days after a scan that showed a gestational sac with a yolk sac
  • sac with no embryo and an MSD <12 mm on initial scan that fails to double in size on a scan ≥14 days later 2
  • sac with no embryo and an MSD ≥12 mm on initial scan with no embryo heart activity on a scan ≥7 days later 2
  • embryo (irrespective of crown-rump length) without cardiac activity on initial scan and on repeat scan ≥7 days later 2
  • cessation of a previously documented cardiac activity of embryo (irrespective of crown-rump length)
  • crown-rump length (CRL) of <7 mm and no heartbeat
  • mean sac diameter (MSD) of 16-24 mm and no embryo
  • absence of embryo with heartbeat 7-13 days after a scan that showed a gestational sac without a yolk sac
  • absence of embryo with heartbeat 7-10 days after a scan that showed a gestational sac with a yolk sac
  • absence of embryo ≥6 weeks after last menstrual period
  • absence of embryo when amnion seen adjacent to yolk sac (empty amnion sign)
  • embryo present with amnion visible around it but no heartbeat (expanded amnion sign)
  • small gestational sac in relation to the size of the embryo (<5 mm difference between mean sac diameter and crown-rump length)
  • enlarged yolk sac (>7 mm)

When there are findings suspicious for pregnancy failure, follow-up ultrasonography at 7-14 days to assess the pregnancy for viability is generally appropriate.

References

  • 1. Doubilet, Peter M., Benson, Carol B., Bourne, Tom, Blaivas, Michael. Diagnostic Criteria for Nonviable Pregnancy Early in the First Trimester. (2013) The New England journal of medicine. 369 (15): 1443-51. doi:10.1056/NEJMra1302417 – Pubmed
  • 2. Preisler J, Kopeika J, Ismail L, Vathanan V, Farren J, Abdallah Y, Battacharjee P, Van Holsbeke C, Bottomley C, Gould D, Johnson S, Stalder C, Van Calster B, Hamilton J, Timmerman D, Bourne T. Defining safe criteria to diagnose miscarriage: prospective observational multicentre study. (2015) BMJ (Clinical research ed.). 351: h4579. doi:10.1136/bmj.h4579 – Pubmed
  • 3. Shuchi K. Rodgers, Crystal Chang, John T. DeBardeleben, Mindy M. Horrow. Normal and Abnormal US Findings in Early First-Trimester Pregnancy: Review of the Society of Radiologists in Ultrasound 2012 Consensus Panel Recommendations. (2015) RadioGraphics. 35 (7): 2135-48. doi:10.1148/rg.2015150092 – Pubmed
  • 4. S E Rowling, B G Coleman, J E Langer, P H Arger, H L Nisenbaum, S C Horii. First-trimester US parameters of failed pregnancy. (1997) Radiology. 203 (1): 211-7. doi:10.1148/radiology.203.1.9122395 – Pubmed
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