![]() ![]() ![]() ![]() The Role of Ultrasound in Confirming a Nonviable Pregnancy ![]() A study of pregnancy viability published in the Journal of Ultrasound in Medicine suggests that similar standards are used in both the EU and Japan. When using abdominal ultrasound, the second scan should be scheduled for at least 25 days later.Įlsewhere in Europe, the European Society for Human Reproduction and Embryology references guidelines from the Royal College of Obstetricians and Gynaecologists, which are based on the NICE recommendations. If a gestational sac is visible but not a fetal pole, a second scan should be performed at least 7 days later, regardless of whether the gestational sac is greater or less than 25 mm in diameter.If abdominal, rather than transvaginal, ultrasound is used, the second scan should be scheduled for at least 14 days later. Whether the CRL is less than or greater than 7 mm, a second scan should be performed at least 7 days later. If there is no cardiac activity, look for the fetal pole and measure the crown-rump length.The National Institute for Health and Care Excellence (NICE) recommends the following diagnostic criteria when determining pregnancy nonviability: A second scan after 11 or more days reveals no heartbeat and gestational sac and yolk sac were visualized previously.A second scan after 2 weeks reveals no heartbeat and no yolk sac was visualized previously.The gestational sac diameter is more than 25 mm but there is no embryo.Embryo crown-rump length (CRL) is more than 7 mm but there is no heartbeat.Either the yolk sac or the embryonic pole can be seen, or neither can be seen.įailed pregnancies are determined with the following criteria:.The gestational sac is visualized and measures at less than 25 mm.Unknown viability is determined with the following criteria: ACOG reiterates these criteria in its practice bulletin on early pregnancy loss. In the United States, criteria for determining pregnancy viability are based on a consensus conference by the Society of Radiologists in Ultrasound. US Standards for Unknown Viability and Failed Pregnancy Early scans may not indicate viability, and physicians should use caution to avoid terminating either an early pregnancy or a "slow-growing pregnancy" without subsequent monitoring, including additional scans at intervals of 10 to 14 days. The authors point out that using diagnostic criteria is vital for avoiding a false positive miscarriage result. The American College of Obstetricians and Gynecologists (ACOG) defines early pregnancy loss as "a nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity" identified within the first 12 to 13 weeks of gestation.Īccording to a study published in The Obstetrician and Gynaecologist, complications peak around 8 to 11 weeks of pregnancy. In a viable pregnancy, an intrauterine gestational sac can be visualized, and contains an embryo with heart activity. Initial results can be misleading, which underscores the need to perform careful ultrasound measurements and repeat examinations so that viable pregnancies do not end in termination. Standards for making this diagnosis differ globally and periodically evolve, most likely because the process of determining viability is not always straightforward. Patients undoubtedly experience high levels of stress and anxiety when trying to achieve a successful pregnancy, and the wait to confirm one is perhaps even more fraught. Confirming a nonviable pregnancy can be disheartening for both physicians and patients, especially after months of IVF cycles or other attempts to conceive. ![]()
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