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Failed First-Trimester Pregnancy
Anne M. Kennedy, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Pregnancy is considered viable if it can potentially result in live birth
            • Nonviable pregnancy is one that will not result in live birth
            • Intrauterine pregnancy (IUP) of uncertain viability
              • Intrauterine gestational sac, no embryonic heartbeat but no definite signs of pregnancy failure on transvaginal ultrasound (TVUS)
            • Pregnancy of unknown location
              • Positive pregnancy test with no identifiable intra- or extrauterine gestational sac on TVUS

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • Imaging Recommendations

                DIFFERENTIAL DIAGNOSIS

                  PATHOLOGY

                  • General Features

                    • Microscopic Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Image Interpretation Pearls

                                  • Reporting Tips

                                    Selected References

                                    1. Hashem A et al: The impact of incidental ultrasound finding of subchorionic and retroplacental hematoma in early pregnancy. J Obstet Gynaecol India. 69(1):43-9, 2019
                                    2. Suguna B et al: Yolk sac size & shape as predictors of first trimester pregnancy outcome: a prospective observational study. J Gynecol Obstet Hum Reprod. 48(3):159-64, 2019
                                    3. Phillips CH et al: First-trimester emergencies: a radiologist's perspective. Emerg Radiol. 25(1):61-72, 2018
                                    4. Benson CB et al: Intrauterine fluid with ectopic pregnancy: a reappraisal. J Ultrasound Med. 32(3):389-93, 2013
                                    5. Doubilet PM et al: Double sac sign and intradecidual sign in early pregnancy: interobserver reliability and frequency of occurrence. J Ultrasound Med. 32(7):1207-14, 2013
                                    6. Doubilet PM et al: Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 369(15):1443-51, 2013
                                    7. Barnhart K et al: Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. Fertil Steril. 95(3):857-66, 2011
                                    8. Doubilet PM et al: First, do no harm... To early pregnancies. J Ultrasound Med. 29(5):685-9, 2010
                                    9. Wang PS et al: Ultrasound of the first trimester. Radiol Clin North Am. 57(3):617-33, 2019
                                    10. Filly MR et al: The yolk stalk sign: evidence of death in small embryos without heartbeats. J Ultrasound Med. 29(2):237-41, 2010
                                    11. Yegul NT et al: The expanded amnion sign: evidence of early embryonic death. J Ultrasound Med. 28(10):1331-5, 2009
                                    12. Lathi RB et al: Cytogenetic testing of anembryonic pregnancies compared to embryonic missed abortions. J Assist Reprod Genet. 24(11):521-4, 2007
                                    13. Cho FN et al: The quality and size of yolk sac in early pregnancy loss. Aust N Z J Obstet Gynaecol. 46(5):413-8, 2006
                                    14. Condous G et al: Pregnancies of unknown location: consensus statement. Ultrasound Obstet Gynecol. 28(2):121-2, 2006
                                    15. Mitwally MF et al: Gestational sac aspiration: a novel alternative to dilation and evacuation for management of early pregnancy failure. J Minim Invasive Gynecol. 13(4):296-301, 2006
                                    16. McKenna KM et al: The empty amnion: a sign of early pregnancy failure. J Ultrasound Med. 14(2):117-21, 1995
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Top Differential Diagnoses

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Definitions

                                              • Pregnancy is considered viable if it can potentially result in live birth
                                              • Nonviable pregnancy is one that will not result in live birth
                                              • Intrauterine pregnancy (IUP) of uncertain viability
                                                • Intrauterine gestational sac, no embryonic heartbeat but no definite signs of pregnancy failure on transvaginal ultrasound (TVUS)
                                              • Pregnancy of unknown location
                                                • Positive pregnancy test with no identifiable intra- or extrauterine gestational sac on TVUS

                                            IMAGING

                                            • General Features

                                              • Ultrasonographic Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Microscopic Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Consider

                                                                  • Image Interpretation Pearls

                                                                    • Reporting Tips

                                                                      Selected References

                                                                      1. Hashem A et al: The impact of incidental ultrasound finding of subchorionic and retroplacental hematoma in early pregnancy. J Obstet Gynaecol India. 69(1):43-9, 2019
                                                                      2. Suguna B et al: Yolk sac size & shape as predictors of first trimester pregnancy outcome: a prospective observational study. J Gynecol Obstet Hum Reprod. 48(3):159-64, 2019
                                                                      3. Phillips CH et al: First-trimester emergencies: a radiologist's perspective. Emerg Radiol. 25(1):61-72, 2018
                                                                      4. Benson CB et al: Intrauterine fluid with ectopic pregnancy: a reappraisal. J Ultrasound Med. 32(3):389-93, 2013
                                                                      5. Doubilet PM et al: Double sac sign and intradecidual sign in early pregnancy: interobserver reliability and frequency of occurrence. J Ultrasound Med. 32(7):1207-14, 2013
                                                                      6. Doubilet PM et al: Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 369(15):1443-51, 2013
                                                                      7. Barnhart K et al: Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. Fertil Steril. 95(3):857-66, 2011
                                                                      8. Doubilet PM et al: First, do no harm... To early pregnancies. J Ultrasound Med. 29(5):685-9, 2010
                                                                      9. Wang PS et al: Ultrasound of the first trimester. Radiol Clin North Am. 57(3):617-33, 2019
                                                                      10. Filly MR et al: The yolk stalk sign: evidence of death in small embryos without heartbeats. J Ultrasound Med. 29(2):237-41, 2010
                                                                      11. Yegul NT et al: The expanded amnion sign: evidence of early embryonic death. J Ultrasound Med. 28(10):1331-5, 2009
                                                                      12. Lathi RB et al: Cytogenetic testing of anembryonic pregnancies compared to embryonic missed abortions. J Assist Reprod Genet. 24(11):521-4, 2007
                                                                      13. Cho FN et al: The quality and size of yolk sac in early pregnancy loss. Aust N Z J Obstet Gynaecol. 46(5):413-8, 2006
                                                                      14. Condous G et al: Pregnancies of unknown location: consensus statement. Ultrasound Obstet Gynecol. 28(2):121-2, 2006
                                                                      15. Mitwally MF et al: Gestational sac aspiration: a novel alternative to dilation and evacuation for management of early pregnancy failure. J Minim Invasive Gynecol. 13(4):296-301, 2006
                                                                      16. McKenna KM et al: The empty amnion: a sign of early pregnancy failure. J Ultrasound Med. 14(2):117-21, 1995