Guidelines for transvaginal ultrasonographic diagnosis of pregnancy failure in a woman with an intrauterine pregnancy of uncertain viability*

Findings diagnostic of pregnancy failure

Findings suspicious for, but not diagnostic of, pregnancy failure^¶

Crown-rump length of ≥7 mm and no heartbeat
Mean sac diameter of ≥25 mm and no embryo
Absence of embryo with heartbeat ≥2 wk after a scan that showed a gestational sac without a yolk sac
Absence of embryo with heartbeat ≥11 days after a scan that showed a gestational sac with a yolk sac

Crown-rump length of <7 mm and no heartbeat
Mean sac diameter of 16 to 24 mm and no embryo
Absence of embryo with heartbeat 7 to 13 days after a scan that showed a gestational sac without a yolk sac
Absence of embryo with heartbeat 7 to 10 days after a scan that showed a gestational sac with a yolk sac
Absence of embryo ≥6 wk after last menstrual period
Empty amnion (amnion seen adjacent to yolk sac, with no visible embryo)
Enlarged yolk sac (>7 mm)
Small gestational sac in relation to the size of the embryo (<5 mm difference between mean sac diameter and crown-rump length)

* Criteria are from the Society of Radiologists in Ultrasound Multispecialty Consensus Conference on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy, October 2012.

¶ When there are findings suspicious for pregnancy failure, follow-up ultrasonography at 7 to 10 days to assess the pregnancy for viability is generally appropriate.

From: Doubilet PM, Benson CB, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 2013; 369:1443. Copyright © 2013 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.

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Guidelines for transvaginal ultrasonographic diagnosis of pregnancy failure in a woman with an intrauterine pregnancy of uncertain viability*