Pregnancy of uncertain viability
Updates to Case Attributes
An intrauterine gestational sac without a visible embryo with a heartbeat constitutes a pregnancy of uncertain viability. A repeat ultrasound should be performed, in a timeframe whereby the diagnosis of either a viable pregnancy or a miscarriage can be made definitively, as ongoing uncertainty and numerous scans could exacerbate the patient's anxiety.
Based on the landmark paper by Preisler et al1, re-scan is recommended as follows:
MSD <12 mm with no embryo - rescan in 14 days
- if MSD has not doubled and there is still no embryo - diagnosis of failed pregnancy can be made
MSD 12-25 mm with no embryo - rescan in 7 days
- if no embryo with cardiac activity present - diagnosis of failed pregnancy can be made.
Please refer to the relevant article on pregnancy of uncertain viability (PUV) for further diagnosis and follow-up guidelines.
Note that quantitative bHCG has no role in the diagnosis of pregnancy failure - criteria are based on ultrasound only. Therefore, the radiology report does need to recommend serial bHCG in the followupfollow-up of PUV.
-<p>An intrauterine gestational sac without a visible embryo with a heartbeat constitutes a pregnancy of uncertain viability. A repeat ultrasound should be performed, in a timeframe whereby the diagnosis of either a viable pregnancy or a miscarriage can be made definitively, as ongoing uncertainty and numerous scans could exacerbate the patient's anxiety. </p><p>Based on the landmark paper by Preisler et al<sup>1</sup>, re-scan is recommended as follows:</p><p>MSD <12 mm with no embryo - rescan in 14 days</p><ul><li>if MSD has not doubled and there is still no embryo - diagnosis of failed pregnancy can be made</li></ul><p>MSD 12-25 mm with no embryo - rescan in 7 days</p><ul><li>if no embryo with cardiac activity present - diagnosis of failed pregnancy can be made.</li></ul><p>Please refer to the relevant article on <a title="Pregnancy of uncertain viability" href="/articles/pregnancy-of-uncertain-viability">pregnancy of uncertain viability</a> (PUV) for further diagnosis and follow-up guidelines. </p><p>Note that quantitative bHCG has no role in the diagnosis of pregnancy failure - criteria are based on ultrasound only. Therefore, the radiology report does need to recommend serial bHCG in the followup of PUV.</p>- +<p>An intrauterine gestational sac without a visible embryo with a heartbeat constitutes a pregnancy of uncertain viability. A repeat ultrasound should be performed, in a timeframe whereby the diagnosis of either a viable pregnancy or a miscarriage can be made definitively, as ongoing uncertainty and numerous scans could exacerbate the patient's anxiety. </p><p>Based on the landmark paper by Preisler et al <sup>1</sup>, re-scan is recommended as follows:</p><p>MSD <12 mm with no embryo - rescan in 14 days</p><ul><li>if MSD has not doubled and there is still no embryo - diagnosis of failed pregnancy can be made</li></ul><p>MSD 12-25 mm with no embryo - rescan in 7 days</p><ul><li>if no embryo with cardiac activity present - diagnosis of failed pregnancy can be made.</li></ul><p>Please refer to the relevant article on <a href="/articles/pregnancy-of-uncertain-viability">pregnancy of uncertain viability</a> (PUV) for further diagnosis and follow-up guidelines. </p><p>Note that quantitative bHCG has no role in the diagnosis of pregnancy failure - criteria are based on ultrasound only. Therefore, the radiology report does need to recommend serial bHCG in the follow-up of PUV.</p>
References changed:
- 1. Preisler J, Kopeika J, Ismail L, Vathanan V, Farren J, Abdallah Y, Battacharjee P, Van Holsbeke C, Bottomley C, Gould D, Johnson S, Stalder C, Van Calster B, Hamilton J, Timmerman D, Bourne T. Defining safe criteria to diagnose miscarriage: prospective observational multicentre study. (2015) BMJ (Clinical research ed.). 351: h4579. <a href="https://doi.org/10.1136/bmj.h4579">doi:10.1136/bmj.h4579</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26400869">Pubmed</a> <span class="ref_v4"></span>
- Preisler J et al. Defining safe criteria to diagnose miscarriage: prospective observational multicentre study. BMJ (Clinical research ed.). 351: h4579.