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Ultrasound
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
L. M. Porche, S. P. Chauhan, A. Abuhamad
Fetal cardiac activity is usually seen once the fetal pole is visible around 6 weeks of gestation. A CRL cutoff of 5 mm without cardiac activity was previously used to diagnose nonviable pregnancy, but a literature review showed that there have been pregnancies that met this criterion that went on to be viable [21, 22]. Interobserver variability in measurements can also lead to inaccurate diagnosis of failed pregnancy. Adopting a CRL cutoff of 7 mm with no visible cardiac activity brings the specificity of this finding for diagnosing failed pregnancy (e.g. embryonic demise, or missed abortion) close to 100% [20].
Implantation and Embryonic Imaging
Published in Mary C. Peavey, Sarah K. Dotters-Katz, Ultrasound of Mouse Fetal Development and Human Correlates, 2021
Mary C. Peavey, Sarah K. Dotters-Katz
An anembryonic pregnancy is one in which the developmental arrest occurred either before the formation of the embryo or before ultrasonography can reliably detect fetal development. This results in the appearance of the gestational sac but without a fetal pole. In humans, findings diagnostic of pregnancy failure include a mean sac diameter of ≥25 mm and no embryo (12). Findings suspicious for, but not diagnostic of, pregnancy failure, mean sac diameter of 16–24 mm and no embryo (12). In mice, a mean sac diameter of >2 mm and no fetal pole is diagnostic of an anembryonic pregnancy. See Fig. 1.11.
Heterotopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Ultrasound is unreliable for the detection of HP, and in one review of the literature, only 66% of cases reviewed were diagnosed sonographically (Figures 8.1 and 8.2) [1]. Signs suggestive of HP are a complex adnexal mass or fluid in the pelvis. If the clinician has a low suspicion for HP after visualizing an intrauterine pregnancy, the ectopic pregnancy may be falsely labeled a corpus luteum cyst. Advanced ectopic gestations containing a yolk sac or fetal pole with cardiac activity make diagnosis easier [17]. The presence of free fluid within the abdomen may be a sign of tubal rupture but may be falsely labeled ascites associated with ovarian hyperstimulation syndrome. Repeated ultrasound tests 2 weeks after the diagnosis of intrauterine pregnancy may prove useful to locate the extra sac(s) in patients in whom this is suspected [18]. Routine transvaginal sonography (TVS) at day 27 after ET could facilitate the diagnosis of HP, and symptom onset before or after day 27 is a clue to early diagnosis [19].
The effect of ultrasound-guided high-intensity focused ultrasound treatment for cesarean scar pregnancy on ovarian reserve
Published in International Journal of Hyperthermia, 2021
Wenping Wang, Jing Jiang, Yan Chen, Chengzhi Li, Honggui Zhou, Zhibiao Wang
In the presence of a positive pregnancy test, a CSP was diagnosed by transvaginal ultrasound using the following criteria [1]: (1) an empty uterus and cervical canal, (2) a gestational sac at the cesarean section scar and the presence of embryonic/fetal pole and/or yolk sac with or without heart activity, (3) thin or absent myometrial tissue between the bladder and the gestational sac, and (4) a prominent and at times rich vascular pattern at or in the area of the cesarean section scar. The included patients who met the above diagnostic criteria were treated with HIFU with or without suction curettage, and follow-up data on AMH levels were obtained before and 3 months after HIFU treatment. The exclusion criteria were as follows: (1) patients who received other treatments for CSP before HIFU and suction curettage (e.g., UAE, MTX, hysterectomy). Upon diagnosis of the CSP, patients had been informed and counseled about the potential risks of the condition and the available treatment plans. The choice of treatment was based on the patients’ informed consent; (2) patients with unstable vital signs, uncontrolled vaginal bleeding, or other conditions not suitable for HIFU; or (3) patients with a history of endocrine diseases, polycystic ovarian disease, ovarian surgery, or a history of radiotherapy and chemotherapy. From January 2018 to December 2019, 32 patients who met the inclusion criteria were enrolled in the study. Figure 1 presents the flow diagram of enrolled patients.
“Does serum estrogen level have an impact on outcomes in hormonal replacement frozen-warmed embryo transfer cycles?”
Published in Gynecological Endocrinology, 2021
Sita Garimella, Sandeep Karunakaran, Durga Rao Gedela
The primary outcome measure was clinical pregnancy rate (CPR). The secondary outcome measures were implantation rate (IR), miscarriage rate (MR), multiple pregnancy rates (MPR) and ectopic pregnancy rates. If there was a gestational sac with heart beat identified by vaginal/abdominal USG at 8 weeks POG it was taken as clinical pregnancy. The ratio of gestational sacs to the number of embryos transferred was the IR. Any pregnancy loss before 12 weeks of gestation was taken as miscarriage. Multiple pregnancy was defined as the presence of more than one fetal pole with cardiac activity detected on ultrasound at 8 weeks gestation. Ectopic pregnancy was defined as a gestational sac seen outside the uterine cavity.
From β-hCG values to counseling in tubal pregnancy: what do women want?
Published in Gynecological Endocrinology, 2019
Lorenzo Sabbioni, Emanuela Carossino, Filiberto Maria Severi, Stefano Luisi
Commonly, a tubal EP is seen as an inhomogeneous mass or blob sign adjacent to the ovary and moving separately from the ovary [6]. Other typical aspects include a mass with a hyper-echoic ring around the gestational sac or, more rarely, a gestational sac with a fetal pole with or without heartbeat, with the presence of cardiac activity being a straightforward contraindication to medical therapy [8]. To do so, we do strongly recommend a routine in the transvaginal exam. First of all, the presence of intracavitary fluid within the endometrial cavity can be easily distinguished from a true gestational sac. The characteristics that distinguish this fluid from an early intrauterine sac were analyzed [1].