Failed early pregnancy : ASUM, RCOG and ACR criteria
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.
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.
For a full description of the relevant conditions, please refer to the individual articles
- 1. Document from the Australasian Society for Ultrasound in Medicine (ASUM) 2005 : Australasian Society for Ultrasound in Medicine (ASUM) Guidelines for the performance of Ultrasound in First Trimester - revised 2005
- 2. Royal College of Obstetricians and Gynaecologists (RCOG) Guideline : The management of early pregnancy loss : Royal College of Obstetricians and Gynaecologists (RCOG) Guideline : The management of early pregnancy loss - revised 2006
- 3. Jauniaux E, Johns J, Burton GJ. The role of ultrasound imaging in diagnosing and investigating early pregnancy failure. Ultrasound Obstet Gynecol. 2005;25 (6): 613-24. doi:10.1002/uog.1892 - Pubmed citation
- 4. Schouwink MH, Fong BF, Mol BW et-al. Ultrasonographic criteria for non-viability of first trimester intra-uterine pregnancy. Early Pregnancy. 2000;4 (3): 203-13. - Pubmed citation
- 5. Hately W, Case J, Campbell S. Establishing the death of an embryo by ultrasound: report of a public inquiry with recommendations. Ultrasound Obstet Gynecol. 1995;5 (5): 353-7. doi:10.1046/j.1469-0705.1995.05050353.x - Pubmed citation
- 6. Document from the Royal College of Obstetricians and Gynaecologists (RCOG) : http://www.rcog.org.uk/files/rcog-corp/Addendum%20to%20GTG%20No%2025.pdf
- 7. Document from the Australasian Society for Ultrasound in Medicine (ASUM) 2005 : http://www.asum.com.au/site/files/P&S/D11_policy.pdf
- 8. http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonWomensImaging/FirstTrimesterBleedingDoc3.aspx
- 9. Document from the Australasian Society for Ultrasound in Medicine (ASUM) 2005 :http://www.asum.com.au/newsite/files/documents/policies/PS/D11_policy.pdf - revised in 2012
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