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Failed early pregnancy : ASUM, RCOG and ACR criteria

Dr Alexandra Stanislavsky et al.

There is some regional variation in the formal criteria for a failed early pregnancy.

The general principles are of course universal, but a critical difference is the cut-off values that are locally accepted to determine embryonal non-viability. 

Regional criteria

RCOG (UK) and ASUM (Australasia) criteria

In October 2011 RCOG had amended their Management of Pregnancy Loss guidelines in response to new research, to take a more conservative approach. In August 2012, ASUM amended their guideline to match the RCOG.

According to the current RCOG/ASUM recommendations 6:

  • anembryonic pregnancy (or delayed miscarriage) is:
    • no fetal pole or yolk sac in a gestational sac with MSD ≥ 25 mm, or
    • no change in MSD on consecutive scans 7 days apart
  • missed miscarriage is:
    • no heart beat in an embryo with CRL ≥ 7 mm, or
    • CRL< 6 mm  and no interval growth over 5 - 7 days

The guidelines stress that a transvaginal examination should be performed in all cases, by an experienced sonographer. 

ACR criteria (US)

At the time of wrting, ACR appropriateness criteria for bleeding in the first trimester8 recommend MSD cut-off of  ≥16mm, and CRL≥5mm.

See also

For a full description of the relevant conditions, please refer to the individual articles

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