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Failed 1st-Trimester Pregnancy
Amelia Wnorowski, MD; Fauzia Vandermeer, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Failed 1st-trimester pregnancy: Collection of diagnoses that reflect nonviable pregnancies
            • Anembryonic pregnancy: Failure of embryo to develop, or early demise with resorption of fetal pole (a.k.a. blighted ovum, less favored term)
              • Gestational sac (GS) ≥ 25 mm with no embryo
            • Embryonic demise: Embryo ≥ 7 mm in length with no heartbeat
            • Spontaneous abortion: Involuntary pregnancy loss in first 20 weeks; may be inevitable, incomplete, or complete
            • Missed abortion: General term for nonviable pregnancy, closed cervix & no clinical signs of miscarriage

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Microscopic Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Image Interpretation Pearls

                                Selected References

                                1. Jensen KK et al: Imaging of acute pelvic pain: pregnant (ectopic and first-trimester viability updated). Radiol Clin North Am. 58(2):347-61, 2020
                                2. Murugan VA et al: Role of ultrasound in the evaluation of first-trimester pregnancies in the acute setting. Ultrasonography. 39(2):178-89, 2020
                                3. Wang PS et al: Ultrasound of the first trimester. Radiol Clin North Am. 57(3):617-33, 2019
                                4. ACOG Practice Bulletin No. 200: Early pregnancy loss. Obstet Gynecol. 132(5):e197-207, 2018
                                5. Rodgers SK et al: Normal and abnormal US findings in early first-trimester pregnancy: review of the Society of Radiologists in Ultrasound 2012 Consensus Panel recommendations. Radiographics. 35(7):2135-48, 2015
                                6. Doubilet PM: Ultrasound evaluation of the first trimester. Radiol Clin North Am. 52(6):1191-9, 2014
                                7. Doubilet PM et al: Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 369(15):1443-51, 2013
                                8. Lane BF et al: ACR Appropriateness Criteria® first trimester bleeding. Ultrasound Q. 29(2):91-6, 2013
                                9. Salamanca A et al: Early embryonic morphology sonographically assessed and its correlation with yolk sac in missed abortion. Arch Gynecol Obstet. 287(1):139-42, 2013
                                10. Abdallah Y et al: Limitations of current definitions of miscarriage using mean gestational sac diameter and crown-rump length measurements: a multicenter observational study. Ultrasound Obstet Gynecol. 38(5):497-502, 2011
                                11. Tan S et al: Irregular yolk sac shape: is it really associated with an increased risk of spontaneous abortion? J Ultrasound Med. 30(1):31-6, 2011
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Top Differential Diagnoses

                                      • Clinical Issues

                                        TERMINOLOGY

                                        • Definitions

                                          • Failed 1st-trimester pregnancy: Collection of diagnoses that reflect nonviable pregnancies
                                          • Anembryonic pregnancy: Failure of embryo to develop, or early demise with resorption of fetal pole (a.k.a. blighted ovum, less favored term)
                                            • Gestational sac (GS) ≥ 25 mm with no embryo
                                          • Embryonic demise: Embryo ≥ 7 mm in length with no heartbeat
                                          • Spontaneous abortion: Involuntary pregnancy loss in first 20 weeks; may be inevitable, incomplete, or complete
                                          • Missed abortion: General term for nonviable pregnancy, closed cervix & no clinical signs of miscarriage

                                        IMAGING

                                        • General Features

                                          • Ultrasonographic Findings

                                            • Imaging Recommendations

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • General Features

                                                  • Microscopic Features

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Jensen KK et al: Imaging of acute pelvic pain: pregnant (ectopic and first-trimester viability updated). Radiol Clin North Am. 58(2):347-61, 2020
                                                              2. Murugan VA et al: Role of ultrasound in the evaluation of first-trimester pregnancies in the acute setting. Ultrasonography. 39(2):178-89, 2020
                                                              3. Wang PS et al: Ultrasound of the first trimester. Radiol Clin North Am. 57(3):617-33, 2019
                                                              4. ACOG Practice Bulletin No. 200: Early pregnancy loss. Obstet Gynecol. 132(5):e197-207, 2018
                                                              5. Rodgers SK et al: Normal and abnormal US findings in early first-trimester pregnancy: review of the Society of Radiologists in Ultrasound 2012 Consensus Panel recommendations. Radiographics. 35(7):2135-48, 2015
                                                              6. Doubilet PM: Ultrasound evaluation of the first trimester. Radiol Clin North Am. 52(6):1191-9, 2014
                                                              7. Doubilet PM et al: Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 369(15):1443-51, 2013
                                                              8. Lane BF et al: ACR Appropriateness Criteria® first trimester bleeding. Ultrasound Q. 29(2):91-6, 2013
                                                              9. Salamanca A et al: Early embryonic morphology sonographically assessed and its correlation with yolk sac in missed abortion. Arch Gynecol Obstet. 287(1):139-42, 2013
                                                              10. Abdallah Y et al: Limitations of current definitions of miscarriage using mean gestational sac diameter and crown-rump length measurements: a multicenter observational study. Ultrasound Obstet Gynecol. 38(5):497-502, 2011
                                                              11. Tan S et al: Irregular yolk sac shape: is it really associated with an increased risk of spontaneous abortion? J Ultrasound Med. 30(1):31-6, 2011