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Age: 34

Sex: Female

Indication: Pregnant with vaginal bleeding

Gestational age: 11 weeks

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Case #18


Findings

  • A single intrauterine gestational sac containing a fetal pole is identified
  • Mean sac diameter: 4 cm
  • Crown-rump length: 1.6 cm
  • Calculated gestational age from crown-rump length measurement is 8 weeks, 0 days
  • No cardiac contractions are seen
  • Normal appearance of the uterus and ovaries


Diagnosis

Pregnancy failure

Sample Report

A single intrauterine gestational sac containing a fetal pole is identified. Mean sac diameter: 4 cm. Crown-rump length: 1.6 cm. No cardiac contractions are seen. These findings are diagnostic of pregnancy failure.

Normal appearance of the uterus and ovaries.


Discussion

  • Pregnancy failure can be an uncertain and anxiety-provoking diagnosis to make
  • Fortunately, there are specific criteria (listed below) for nonviable first trimester pregnancy that can alleviate some of this anxiety and encourage standard interpretation of these studies
  • Beta-hCG values are not particularly useful in and of themselves in determining pregnancy viability, but can be useful to know since intrauterine gestations are not typically visible until the beta-hCG serum value reaches about 2000 mIU/mL (though are sometimes visible earlier) and are almost always visible at beta-hCG serum values above 3000 mIU/mL

 

Finding Diagnostic for Nonviable Pregnancy in the First Trimester

Crown-rump length ≥ 7 mm with no heartbeat
Mean sac diameter ≥ 25 mm with no embryo
No embryo with heartbeat ≥ 2 weeks after a scan showing a gestational sac without a yolk sac
No embryo with heartbeat ≥ 11 days after a scan showing a gestational sac with a yolk sac



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