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 assessment
Ultrasound
Findings diagnostic of pregnancy failure
- crown-rump length (CRL) of ≥7 mm and no heartbeat on a tranvaginal scan
- mean sac diameter (MSD) of ≥25 mm and no embryo on a tranvaginal scan
- 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
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
- amnion seen adjacent to yolk sac, with no visible embryo (empty amnion sign)
- enlarged yolk sac (>7 mm)
- small gestational sac in relation to the size of the embryo (<5 mm difference between mean sac diameter and crown-rump length)
- large amniotic cavity (expanded amnion sign)
Practical points
When there are findings suspicious for pregnancy failure, follow-up ultrasonography at 7-10 days to assess the pregnancy for viability is generally appropriate.
See also
-<a href="/articles/crown-rump-length">crown-rump length</a> (CRL) of ≥<strong>7</strong> mm and no heartbeat</li>- +<a href="/articles/crown-rump-length">crown-rump length</a> (CRL) of ≥<strong>7</strong> mm and no heartbeat on a tranvaginal scan</li>
-<a href="/articles/mean-sac-diameter">mean sac diameter</a> (MSD) of ≥<strong>25</strong> mm and no embryo</li>- +<a href="/articles/mean-sac-diameter">mean sac diameter</a> (MSD) of ≥<strong>25</strong> mm and no embryo on a tranvaginal scan</li>