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Ultrasound
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
L. M. Porche, S. P. Chauhan, A. Abuhamad
A gestational sac is normally noted within the uterus by 5 weeks of gestation. Shortly thereafter at approximately 5 ½ weeks in a normal pregnancy, the yolk sac appears, followed by the fetal pole at 6 weeks. When measuring the gestational sac, dimensions are recorded in three orthogonal planes; the average of the measurements is the mean sac diameter. A mean gestational sac diameter of ≥25 mm without an embryo is diagnostic of pregnancy failure (e.g. anembryonic pregnancy, or blighted ovum) with positive predictive value approaching 100% [21] (See also Chap. 16). An intrauterine gestational sac should be visible by transvaginal ultrasound with a serum beta-human chorionic gonadotropin (B-hCG) of >1500 mIU/mL. If this is not the case, ectopic pregnancy should be suspected.
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
In the mouse, a gestational sac should form at each implantation site, which should remain roughly equally distributed throughout each horn, both proximally and distally. Similar to human development, the gestational sac is visualized as a small, round, anechoic area in the site of the implantation area. The appearance of a gestational sac reliably occurs between 6.5 and 7.5 dpc. The absence of a gestational sac on 7.5 dpc confirms an abnormal pregnancy that will not progress into a viable pregnancy. See Figs. 1.6 and 1.7.
Sonoembryology
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
At 5 weeks and 0 days, the gestational sac measures 5 or 6 mm in diameter [18]. At the beginning of the fifth week, a small secondary yolk sac is visible as the earliest sign of the developing embryo [19,22]. At the end of the fifth week, an embryo measuring 2–3 mm in length can be seen as a small straight line adjacent to the yolk sac [18,19,22]. As the connecting stalk is short, the embryonic pole is found near the wall of the gestational sac. Even though the embryo is so small, heartbeats at a rate of about 100 bpm can frequently be detected within the embryonic pole [18,26] (Video 14.1).
Extended culture of cleavage-stage embryos in vitrified–thawed cycles may be an alternative to frozen and thawed blastocysts during in vitro fertilization
Published in Gynecological Endocrinology, 2022
Pinar C. Aytac, Esra B. Kilicdag
Pregnancy was defined as a human chorionic gonadotrophine (HCG) level higher than 10 IU/l noted 10 days after embryo transfer. If the HCG level then doubled two days later, patients were evaluated by transvaginal ultrasound to check gestational sac and fetal heart beat in two weeks time. A clinical pregnancy was defined as a gestational sac in uterus around 6th or 7th week of gestation. If HCG levels did not increase properly, one week later we examined our patient to rule out ectopic pregnancy versus chemical abortus. Pregnancy rate was defined as a positive pregnancy tests per IVF cycle, while clinical pregnancy rate was defined as a positive gestational sac per IVF cycle. Live birth rate was defined as the number of live born babies per 100 embryo transfers. Chemical abortus was noted if HCG levels decreased and no gestational sac was seen in the uterus. Implantation ratio was defined as a ratio of the number of gestational sacs over the number of transferred embryos. Abortus was defined as gestational sac without fetal heart beat or expulsion of gestational sac with vaginal bleeding before 20 weeks of gestation. Early abortus was defined as a pregnancy not proceeding beyond 12 weeks of gestation, while late abortus was a pregnancy ending between 12 and 20 weeks of gestation.
Abdominal ectopic pregnancy
Published in Baylor University Medical Center Proceedings, 2021
Reshma George, Edward Powers, Robert Gunby
Risk factors for abdominal pregnancy include previous ectopic pregnancy, tubal surgeries/rupture, endometriosis, and pelvic inflammatory disease.1 While abdominal pregnancy presentation is variable, findings such as severe abdominal pain and painful fetal movement should raise suspicion for abdominal pregnancy.6 Due to the variability of symptoms, abdominal pregnancies can be misdiagnosed.5 In our case, the pregnancy was initially thought to be intrauterine; however, a sonogram showed the presence of an extrauterine pregnancy. Ultrasound findings showing an empty uterus, with a gestational sac or mass outside of the uterus, fallopian tubes, and ovaries confirming the diagnosis of abdominal pregnancy.1,5 If the diagnosis of abdominal pregnancy is inconclusive with ultrasound findings, magnetic resonance imaging can be used.5 Further, beta-human chorionic gonadotropin levels early in the pregnancy >1500 mIU/mL without an intrauterine gestational sac should warrant concern for abdominal or other ectopic pregnancies.8
Further evidence that a supraphysiologic estradiol level during ovarian stimulation affects birthweight: findings of fresh and frozen embryo transfer with comparable estradiol levels on human chorionic gonadotropin trigger
Published in Gynecological Endocrinology, 2021
Lu Luo, Huiying Jie, Minghui Chen, Limei Zhang, Yanwen Xu
For FET cycles, endometrium was prepared with natural cycles or hormone replacement cycles. For natural cycles, embryos were transferred on the third (for D3 embryos) or fifth (for blastocysts) day after ovulation. Hormone replacement therapy for hormone replacement cycles was initiated on days 3–5 of a spontaneous menstrual cycle or 3–5 days after progesterone withdrawal bleeding. The initial dose of estradiol valerate was 2 mg twice per day. Vaginal ultrasound and hormone assays were performed to adjust the dosage. If the endometrial thickness reached 8 mm and the serum E2 level reached 100 pg/mL, oral E2 was continued and an intramuscular injection of 40 mg progesterone was given for two days, followed by 60 mg for the following 15 days. Embryos were transferred on the fourth or sixth day of progesterone treatment. Pregnancy tests were conducted 12 days after ET. Clinical pregnancy was defined as intrauterine gestational sac observed at 7 weeks of gestation.