The sonographic findings are only one part of the puzzle in determining if a pregnancy is nonviable. This article will focus on the criteria for the sonographic diagnosis of a nonviable intrauterine pregnancy early in gestation, those sonographic findings that are suspicious to result in an early pregnancy loss, and the vital role of ultrasound in these frequent clinical scenarios.
6,7 Inadvertent misclassification of potentially viable pregnancy as nonviable with resultant medical or surgical intervention resulting in the iatrogenic termination of a desired pregnancy has significant consequences to the family and may be an inciting factor in malpractice cases. This change was made with the expectation of a diagnostic specificity of 100% (no false positives), while accounting for intra and interobserver variability in measurements as well as a range in practice conditions and experience. In 2013, the Society of Radiologists in Ultrasound (SRU) convened a multispecialty panel on early first-trimester diagnosis of miscarriage and exclusion of a viable intrauterine pregnancy (cannot result in the birth of a live baby) and published a more conservative approach to defining a pregnancy as nonviable. Historically, these criteria were based on small studies a CRL of ≥ 5mm and mean sac diameter of≥ 16-17 mm without an embryo were considered diagnostic for an early pregnancy loss.1,5Over the last decade, the reliability of these thresholds has been called into question. Ultrasonography (usually transvaginal) in combination with β-hCG and clinical history is instrumental for making the diagnosis of a nonviable pregnancy with certainty.
1-3 With the adoption of early home pregnancy testing, women are commonly referred for sonographic evaluations very early in gestation to determine pregnancy location and viability.Īlthough we believe ultrasound to be indispensable for the management of suspected early pregnancy failure, if performed too early or without strict adherence to guidelines, it may lead to inconclusive results or an incorrect diagnosis of an early pregnancy loss. The cessation of development occurs in approximately 10-20% of clinically recognized pregnancies, increasing with advancing parental age. Early pregnancy loss (miscarriage) is defined as a nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without cardiac activity within the first 12 6/7 weeks of gestation.
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