Failed early pregnancy
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Failed early pregnancy refers to the death of the embryo and therefore, miscarriage. The most common cause of embryonic death is a chromosomal abnormality.
Radiographic features
Ultrasound
Findings diagnostic of pregnancy failure
- 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)
Findings suspicious but not diagnostic of pregnancy failure
- 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)
Practical points
When there are findings suspicious for pregnancy failure, follow-up ultrasonography at 7-14 days to assess the pregnancy for viability is generally appropriate.
See also
-<li>absence of embryo with heartbeat ≥2 weeks after a scan that showed a gestational sac without a yolk sac</li>- +<li>absence of <a href="/articles/embryo">embryo</a> with heartbeat ≥2 weeks after a scan that showed a gestational sac without a yolk sac</li>
-<li>embryo (irrespective of crown-rump length) without cardiac activity on initial scan and on repeat scan ≥7 days later <sup>2</sup>- +<li>embryo (irrespective of crown-rump length) without <a href="/articles/fetal-cardiac-activity">cardiac activity</a> on initial scan and on repeat scan ≥7 days later <sup>2</sup>
-</ul><h4>Practical points</h4><p>When there are findings suspicious for pregnancy failure, follow-up ultrasonography at 7-14 days to assess the pregnancy for viability is generally appropriate.</p><h4>See also</h4><ul><li><a href="/articles/threatened-miscarriage">threatened miscarriage</a></li></ul>- +</ul><h4>Practical points</h4><p>When there are findings suspicious for pregnancy failure, follow-up ultrasonography at 7-14 days to assess the pregnancy for viability is generally appropriate.</p><h4>See also</h4><ul>
- +<li><a href="/articles/threatened-miscarriage">threatened miscarriage</a></li>
- +<li><a title="Fetal death in utero" href="/articles/fetal-death-in-utero-1">fetal death in utero</a></li>
- +</ul>