![]() ![]() In a substantial number of patients evaluated in the emergency department during very early pregnancy, the location of the gestational sac is inconclusive. Pregnancy of Unknown Location and Ectopic Pregnancy The previously seen gestational sac in the cervix was no longer seen, compatible with a completed abortion. The patient passed a few clots and transvaginal images were obtained. Gestational sac containing a fetal pole was identified in the cervix (arrow) the abortion was in progress. Ĭompleted abortion: transabdominal and transvaginal ultrasonography obtained in a patient with a confirmed intrauterineĪ, B. Lastly, a missed abortion is a nonviable pregnancy with a closed cervix and no clinical symptoms of miscarriage. A completed abortion is the cessation of vaginal bleeding following the passage of the pregnancy without retained products of conception ( Fig. While it may be avascular, the presence of blood flow enables the diagnosis of retained products. This often appears as a heterogeneous collection or mass within the uterus. An incomplete abortion is the term used when the retained products of conception remain within the uterus after passage of the pregnancy. The products of conception may be normally or abnormally positioned within the uterus or may protrude into the cervix. An inevitable abortion involves a similar clinical situation with vaginal bleeding and abdominal cramping, but with an open cervical os on TVUS ( Fig. Poor prognostic indicators include abnormal morphology (e.g., a small or irregular gestational sac), fetal bradycardia, or a large SCH. The pregnancy itself may appear normal or may demonstrate abnormal features. A threatened abortion refers to a clinical scenario in which a patient presents with vaginal spotting/bleeding and cramping/contractions with a closed cervical os. There are various stages of spontaneous abortion. ![]() Spontaneous abortion or miscarriage is clinically defined as the loss of a pregnancy before the 20th week of gestation or the expulsion of a fetus weighing less than 500 g. Through these guidelines, the SRU aims to achieve 100% specificity for defining pregnancy failure and to sustain a primum non nocere approach given the calamitous outcome of a potentially normal pregnancy following treatment for an incorrectly diagnosed pregnancy failure ( Table 2). In addition, other findings including the empty amnion sign, a yolk sac greater than 7 mm, and a disproportionately small gestational sac are highly suspicious for pregnancy failure ( Fig. The SRU has presented specific guidelines for diagnosing pregnancy failure based on certain characteristics: namely, (1) the CRL measurement by which an embryonic heart rate must be identified (7 mm), (2) the MSD by which an embryo should be identified (25 mm), and (3) the absence of an embryo in two consecutive ultrasound exams separated by a fixed time interval. Deviations from the normal chronological appearance of these structures are highly suspicious for pregnancy failure. The timeline of visualization of the gestational sac, yolk sac, and embryo at 5, 5.5, and 6 weeks, respectively, are accurate and consistent. Once an IUP is identified, the viability and presence or absence of abnormal features must be evaluated. Practice parameters for the performance and recording of obstetric ultrasound images have been described by the American Institute of Ultrasound in Medicine. In addition, it can be used to evaluate ectopic pregnancy and other pregnancy-related complications. In the first trimester, pelvic ultrasound is employed to establish the presence or absence of an intrauterine gestational sac and to evaluate the viability of the pregnancy. Ultrasound is then utilized during the first and second trimesters to establish the gestational age of the pregnancy and eventually to evaluate fetal anatomy. The initial diagnosis of pregnancy is usually made by identifying the presence of serum beta-human chorionic gonadotropin (β-hCG). The advantages of ultrasound imaging include its widespread availability, relatively low cost, and the acquisition of real-time, high-resolution images. During the first trimester, transvaginal ultrasonography (TVUS) is the imaging modality of choice for both diagnosis and imaging follow-up. The first trimester of pregnancy consists of the first 12-13 weeks, calculated as beginning on the first date of the last menstrual period (LMP).
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