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Failed First Trimester Pregnancy
Fauzia Vandermeer, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Failed first trimester pregnancy refers to collection of specific diagnoses that are nonviable
              • Avoids confusion and simplifies terminology
            • Anembryonic pregnancy (AP): Failure of embryo to develop or early demise with resorption of embryonic pole (a.k.a. "blighted ovum," less favored term)
            • Embryonic demise (ED): Embryo ≥ 7 mm in length with no heartbeat
            • Spontaneous abortion: Involuntary pregnancy loss in 1st 20 weeks; may be inevitable, incomplete, or complete
            • Missed abortion: General term for ED or AP; latter terms are more accurate and preferred

          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. Doubilet PM: Ultrasound evaluation of the first trimester. Radiol Clin North Am. 52(6):1191-9, 2014
                                2. Doubilet PM et al: Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 369(15):1443-51, 2013
                                3. Lane BF et al: ACR appropriateness Criteria® first trimester bleeding. Ultrasound Q. 29(2):91-6, 2013
                                4. 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
                                5. 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
                                6. Jeve Y et al: Accuracy of first-trimester ultrasound in the diagnosis of early embryonic demise: a systematic review. Ultrasound Obstet Gynecol. 38(5):489-96, 2011
                                7. Papaioannou GI et al: Ultrasonographic prediction of early miscarriage. Hum Reprod. 26(7):1685-92, 2011
                                8. 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 first trimester pregnancy refers to collection of specific diagnoses that are nonviable
                                            • Avoids confusion and simplifies terminology
                                          • Anembryonic pregnancy (AP): Failure of embryo to develop or early demise with resorption of embryonic pole (a.k.a. "blighted ovum," less favored term)
                                          • Embryonic demise (ED): Embryo ≥ 7 mm in length with no heartbeat
                                          • Spontaneous abortion: Involuntary pregnancy loss in 1st 20 weeks; may be inevitable, incomplete, or complete
                                          • Missed abortion: General term for ED or AP; latter terms are more accurate and preferred

                                        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. Doubilet PM: Ultrasound evaluation of the first trimester. Radiol Clin North Am. 52(6):1191-9, 2014
                                                              2. Doubilet PM et al: Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med. 369(15):1443-51, 2013
                                                              3. Lane BF et al: ACR appropriateness Criteria® first trimester bleeding. Ultrasound Q. 29(2):91-6, 2013
                                                              4. 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
                                                              5. 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
                                                              6. Jeve Y et al: Accuracy of first-trimester ultrasound in the diagnosis of early embryonic demise: a systematic review. Ultrasound Obstet Gynecol. 38(5):489-96, 2011
                                                              7. Papaioannou GI et al: Ultrasonographic prediction of early miscarriage. Hum Reprod. 26(7):1685-92, 2011
                                                              8. 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