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Age: 22

Sex: Female

Indication: Pregnant, vaginal bleeding

Gestational age: 10 weeks

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Case #19


Findings

  • A gestational sac containing an embryo is visualized in the lower uterine segment extending into the cervical canal approaching the external cervical os
  • Mean sac diameter: 3.5 cm
  • Crown-rump length: 2.8 cm
  • Estimated gestational age: 9 weeks, 4 days by crown-rump length
  • Cardiac contractions are not visualized
  • Anechoic structure in the left ovary with peripheral vascularity consistent with a corpus luteum
  • Trace free fluid in the cul-de-sac


Diagnosis

Spontaneous abortion in progress

Sample Report

Single intrauterine gestation with crown-rump length measuring 2.8 cm and no cardiac contractions visualized. These findings are diagnostic of pregnancy failure. The gestational sac is positioned in the lower uterine segment extending into the cervical canal approaching the external cervical os, consistent with spontaneous abortion in progress.

Left ovarian corpus luteum with otherwise normal appearance of the uterus and ovaries.

Trace free fluid in the cul-de-sac.


Discussion

  • Spontaneous abortion (miscarriage) is a feared complication of pregnancy and is most common in the first trimester
  • Embryonic demise is a common precipitating factor, so it is important to assess the embryo in clinical cases of threatened abortion
  • There are a variety of terms used to describe stages of spontaneous abortion, including:
    • Threatened abortion – questionable embryo viability without evidence for initiation of abortion
      • Embryo factors including bradycardia, small gestational sac relative to the embryo, enlarged yolk sac
      • Subchorionic hemorrhage – especially when large or encompassing 2/3 or more of the gestational sac
    • Abortion in progress – gestational sac migrates to the lower uterine segment and passes through the cervix
    • Completed abortion – gestational sac is no longer in the uterus
    • Missed abortion – deceased embryo remains in the uterus after patient’s symptoms have resolved
  • Keep in mind the following conditions which may mimic stages of spontaneous abortion:
    • Cervical ectopic pregnancy – may appear similar to abortion in progress. Followup imaging can help differentiate the two if the imaging and clinical pictures are ambiguous
    • Pregnancy of unknown location – may appear similar to completed abortion (neither has a visible gestational sac in the uterus). Trending beta-hCG values is useful as they should increase in a viable pregnancy and decrease following spontaneous abortion



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