Sonology: When to term as nonviable intrauterine pregnancy or say failed intrauterine pregnancy with confidence?
Ans: Absolute criteria for a failed intrauterine
pregnancy include any of the followings :-
A)
crown–rump length greater than or equal to 7 mm with no fetal heart rate,
B) A mean sac diameter greater
than or equal to 25 mm with no embryo,
C) Absence of an embryo with absence of fetal heart flicker for 2
weeks and above following an previous ultrasound with a prior gestational sac
without a yolk sac,
and D) absence
of an embryo and also a fetal heart rate for 11 days or more after a previous scan
demonstrating a gestational sac with a yolk sac .
When any of the
previous criteria are met, a patient can safely be diagnosed with a nonviable
intrauterine pregnancy.
Source :-Doubilet, P., Benson, C. B., Bourne, T., & Blaivas, M. (2013).
Diagnostic criteria for non-viable pregnancy early in the first trimester. New
England Journal of Medicine, 369, 1443–1451.
Appearance of
cardiac Flicker??? At CRL of 8mm cardiac Flicker is observed but it is equally
true that if one sees an embryo it has to have cardiac flicker, but picking it
up depends on ones machine and ones imaging ability.On the whole an embryo of 5-6mm
will have flicker and a F pole of more than 7mm with no flicker makes doubt of
healthy pregnancy. If CRL is 3mm or more, then cardiac activity must seen,
if absent it is missed abortion
A common question is “if asymptomatic then should we terminate? Or should we wait for another scan?” Any such good experience? Ans: I am of the opinion of not prescribing drugs for medl abortion. Not to rush for induction of abortion more so if decidual reaction is good, and serum beta HCG are reassuring. Then we can wait. One can wait for one week or so with the hope that in case FHR was missed in earlier scan.
For TVS at
6 wks cardiac activity is seen 25 mm of MSD and 7 mm of CRL
The
earliest possible time when the cardiac flicker could be seen is when the embryo is 2mm
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