Ultrasound Criteria for Diagnosis of Early Pregnancy Failure and Ectopic Pregnancy

Abstract

Early pregnancy failure and ectopic pregnancy are common clinical diagnoses for which ultrasound can provide useful information. This review explores the use of ultrasound to diagnose early pregnancy failure and ectopic pregnancy. By documenting the developmental milestones of early normal pregnancy using ultrasound, clinicians can distinguish normal from abnormal intrauterine pregnancies. An early pregnancy failure can be diagnosed by the absence of a visible yolk sac with a mean sac diameter of 13 mm; the absence of a visible embryo with a mean sac diameter of 20 [corrected] mm; the absence of cardiac motion with an embryo measuring 5 mm or more in maximal length; or the presence of an empty amnion. In most settings, documentation of a normal intrauterine pregnancy effectively eliminates the possibility of ectopic pregnancy. The presence of an adnexal mass in the absence of an intrauterine gestational sac may indicate an ectopic pregnancy.

Ectopic Pregnancy:

“…The concept of a ''discriminatory zone'' which is the hCG level above which we expect to see an intrauterine gestational sac has been an important addition to the early diagnosis of an ectopic pregnancy. [6][7][8][9][10][11][12] TREATMENT Treatment choice for ectopic pregnancy depends on pregnancy location, presenting symptoms, gestational age, and the patient's desire for future fertility. An ectopic pregnancy discovered early in the first trimester in an asymptomatic patient can often be treated without surgery.…”

Triple ultrasound markers including fetal cardiac activity are related to miscarriage risk

“…In the treatment of infertility patients, there is a desire to provide early reassurance. Ultrasound markers have been examined previously; the relationships of normal fetal cardiac activity (9)(10)(11)(12)(13)(14), the presence and size of a yolk sac (15)(16)(17)(18)(19)(20)(21), and the size of gestational sac to pregnancy outcomes have been reported (22)(23)(24)(25)(26)(27)(28). However, these studies had inherent limitations and have reported conflicting results.…”

Limitations of current definitions of miscarriage using mean gestational sac diameter and crown–rump length measurements: a multicenter observational study

“…A CRL cut‐off value of ≥ 4 mm with no cardiac activity has also been suggested6. A review article has proposed a CRL cut‐off of ≥ 5 mm and an appropriate cut‐off value for MSD of ≥ 13 mm with or without a yolk sac7. Against this background, it is concerning that Elson et al 8 reported two pregnancies with empty gestational sacs measuring 18 and 20 mm that were found to be viable after further follow‐up.…”