Semin Reprod Med 2000; 18(4): 351-356
DOI: 10.1055/s-2000-13724
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

The Sonography of Pregnancy Loss

Robert H. Ball
  • Department of Obstetrics & Gynecology and OB Diagnostic and Treatment Center, University of Utah Health Sciences Center, Salt Lake City, Utah
Further Information

Publication History

Publication Date:
31 December 2000 (online)

ABSTRACT

Sonography is critical to the current management of pregnancy loss. It is used to predict and/or confirm viability. Knowledge of the early embryology as well as the timing of these events is important to appropriate management. Sonographic parameters can be divided into hard and soft signs. Hard signs include the absence of visible heart motion or embryonic poles at certain cutoffs. The soft signs are generally related to findings more likely to be associated with poor outcomes. Ultrasound is now also used to help determine which patients may not require surgical intervention.

REFERENCES

  • 1 de Crispigny C L, Cooper D, McKenna M. Early detection of intrauterine pregnancy with ultrasound.  J Ultrasound Med . 1988;  7 7
  • 2 Nyberg D A, Mack L A, Laing F C, Patten R M. Distinguishing normal from abnormal gestational sac growth in early pregnancy.  J Ultrasound Med . 1987;  6 23
  • 3 Warren W B, Timor-Tritsch I, Peisner O B. Dating the early pregnancy by sequential appearance of embryonic structures.  Am J Obstet Gynecol . 1989;  161 747
  • 4 Levi C S, Lyons E A, Zheng X H. Endovaginal US: demonstration of cardiac activity in embryos of less than 5.0 mm in crown-rump length.  Radiology . 1990;  176 71
  • 5 Jain K A, Hamper U M, Sanders R C. Comparison of transvaginal and transabdominal sonography in detection of early pregnancy and its complications.  AJR . 1988;  151 1139
  • 6 Levi C S, Lyons E A, Lindsay D J. Early diagnosis of nonviable pregnancy with endovaginal US.  Radiology . 1988;  167 383
  • 7 Bree R L, Edwards M, Bohm-Velez M. Transvaginal sonography in the evaluation of normal early pregnancy: correlation with hCG levels.  AJR . 1989;  153 75
  • 8 Kurtz A B, Needleman L, Pennell R G. Can detection of the yolk sac in the first trimester be used to predict the outcome of the pregnancy?.  <~>A prospective sonographic study. AJR . 1992;  158 843
  • 9 Deaton J L, Honore G M, Huffman C S, Bauguess P. Early ultrasound following an accurately dated pregnancy: the importance of finding a yolk sac or fetal heart motion.  Hum Reprod . 1997;  12 2820
  • 10 Rowling S E, Coleman B G, Langer J E. First-trimester US parameters of failed pregnancy.  Radiology . 1997;  203 211
  • 11 Wilson R D, Kendrick V, Wittman B K. Spontaneous abortion and pregnancy outcome after normal first trimester ultrasound exam.  Obstet Gynecol . 1986;  67 352
  • 12 Goldstein R B. Endovaginal sonography in very early pregnancy: new observations.  Radiology . 1990;  167 7
  • 13 Laufer M R, Ecker J L, Hill J A. Pregnancy outcome following ultrasound-detected fetal cardiac activity in women with a history of multiple spontaneous abortions.  J Soc Gynecol Invest . 1994;  1 138
  • 14 Schmidt-Sarosi C, Schwartz L B, Lublin J. Chromosomal analysis of early fetal losses in relation to transvaginal ultrasonographic detection of fetal heart motion after infertility.  Fertil Steril . 1998;  69 274
  • 15 Ferrazzi E, Brambati B, Lanzani A. The yolk sac in early pregnancy failure.  Am J Obstet Gynecol . 1988;  158 137
  • 16 Stampone C, Nicotra M, Muttinelli C, Cosmi E V. Transvaginal sonography of the yolk sac in normal and abnormal pregnancy.  J Clin Ultrasound . 1996;  24 3
  • 17 McKenna K M, Feldstein V A, Goldstein R B, Filly R A. Empty amnion: a sign of early pregnancy failure.  J Ultrasound Med . 1995;  14 117
  • 18 Nazari A, Check J H, Epstein R H. Relationship of small-for-dates sac size to crown-rump length and spontaneous abortion in patients with a known date of ovulation.  Obstet Gynecol . 1991;  78 369
  • 19 Bromley B, Harlow B L, Laboda L A, Benacerraf B R. Small sac size in the first trimester: a predictor of poor fetal outcome.  Radiology . 1991;  178 375
  • 20 Dickey R P, Olar T T, Taylor S N. Relation of small gestation sac-crown-rump length differences to abortion and abortus karyotypes.  Obstet Gynecol . 1992;  79 554
  • 21 Falco P, Milano V, Pilu G. Sonography of pregnancies with first-trimester bleeding and a viable embryo: a study of prognostic indicators by logistic regression analysis.  Ultrasound Obstet Gynecol . 1996;  7 165
  • 22 Laboda L, Estroff J A, Benacerraf B R. First trimester bradycardia: a sign of impending fetal loss.  J Ultrasound Med . 1989;  8 561
  • 23 Howe R S, Isaacson K J, Albert J L, Coutifaris C B. Embryonic heart rate in human pregnancy.  J Ultrasound Med . 1991;  10 367
  • 24 Stefos T I, Lolis D E, Sotiriadis A J, Ziakas G V. Embryonic heart rate in early pregnancy.  J Clin Ultrasound . 1998;  26 33
  • 25 Ball R H, Ade C M, Schoenborn J A, Crane J P. The clinical significance of ultrasonographically detected subchorionic hemorrhages.  Am J Obstet Gynecol . 1996;  174 996
  • 26 Bennett G L, Bromley B, Lieberman E, Benacerraf B R. Subchorionic hemorrhage in first-trimester pregnancies: prediction of pregnancy outcome with sonography.  Radiology . 1996;  200 803
  • 27 Kurjak A, Schulman H, Zudenigo D. Subchorionic hematomas in early pregnancy: clinical outcome and blood flow patterns.  J Matern Fetal Med . 1996;  5 41
  • 28 Goldstein S R, Kerenyi T, Scher J, Papp C. Correlation between karyotype and ultrasound findings in patients with failed early pregnancy.  Ultrasound Obstet Gynecol . 1996;  8 314
  • 29 Coulam C B, Goodman C, Dorfmann A. Comparison of ultrasonographic findings in spontaneous abortions with normal and abnormal karyotypes.  Hum Reprod . 1997;  12 823
  • 30 Schmidt-Sarosi C, Schwartz L B, Lublin J. Chromosomal analysis of early fetal losses in relation to transvaginal ultrasonographic detection of fetal heart motion after infertility.  Fertil Steril . 1998;  69 274
  • 31 Frates M C, Doubilet P M, Brown D L. Role of Doppler ultrasonography in the prediction of pregnancy outcome in women with recurrent spontaneous abortion.  J Ultrasound Med . 1996;  15 557
  • 32 Leible S, Cumsille F, Walton R. Discordant uterine artery velocity waveforms as a predictor of subsequent miscarriage in early viable pregnancies.  Am J Obstet Gynecol . 1998;  179 1587
  • 33 Alcazar J L, Ruiz-Perez M L. Uteroplacental circulation in patients with first-trimester threatened abortion.  Fertil Steril . 2000;  73 130
  • 34 Cetin A, Cetin M. Diagnostic and therapeutic decision-making with transvaginal sonography for first trimester spontaneous abortion, clinically thought to be incomplete or complete.  Contraception . 1998;  57 393
  • 35 Schwarzler P, Holden D, Nielsen S. The conservative management of first trimester miscarriages and the use of color Doppler sonography for patient selection.  Hum Reprod . 1999;  14 1341