EARLY Pregnancy failure.pptx

early pregnancy failure
symptoms of pregnancy failure
causes of pregnancy failure

1. EARLY Pregnancy failure Dr. Justin James

2. all of the following could be described as “early pregnancy failure” A large, empty gestational sac A gestational sac and yolk sac only A smaller-than-normal sized embryo An appropriate sized embryo with no cardiac activity O nly the remnants of a gestational sac

3. RISK FACTORS Advanced maternal age Tobacco Alcohol Chromosomal abnormality Bleeding in 1 st trimester (esp. in 5-12 weeks) Luteal phase : Shortened luteal phase : ovulation induction, IVF Luteal dysfunction – obese, >35 years Abnormal luteal angiogenesis. RI of intra-ovarian arteries <0.5 (high resistance)

4. Sonographic findings definitive for failed Intra uterine pregnancy Crown-Rump Length With No Embryonic Heartbeat Mean Sac Diameter With No Embryo Time-Based Criteria for Pregnancy Failure Here it is safe to undertake an intervention such as uterine evacuation without further follow up.

5. Crown-Rump Length With No Embryonic Heartbeat CRL >/= 7 mm but absent cardiac activity An embryo ( calipers ) 9 mm in length is seen within the uterus. No heartbeat was detected within it : Definitive for failed intra uterine pregnancy

6. Mean Sac Diameter With No Embryo MSD ≥ 25 mm but Gestational sac containing no embryo MSD = 32.6 mm, the average of the anteroposterior, transverse, and sagittal measurements of the gestational sac on sagittal (SAG) and coronal (COR) images of the gestational sac. No embryo is seen. Definitive for Failed intrauterine pregnancy.

7. Time-Based Criteria for Pregnancy Failure Either of the two scenarios : No embryo with heartbeat on a follow-up scan at least 2 weeks (14 days) after an initial scan that showed a gestational sac without a yolk sac No embryo with heartbeat on a follow-up scan at least 11 days after an initial scan that showed a gestational sac with a yolk sac

8. Sonographic Findings Suspicious for Failed Intrauterine Pregnancy Absence of cardiac activity when CRL < 7mm MSD of 16 – 24 mm without identifiable embryo Time based findings No embryo with heartbeat on a follow-up scan 7- 13 days after an initial scan that showed a gestational sac without a yolk sac No embryo with heartbeat on a follow-up scan 7- 10 days after an initial scan that showed a gestational sac with a yolk sac

9. MSD = 21.8 mm. No embryo seen. Suspected pregnancy failure. CRL = 3 cm. No cardiac activity seen. Suspected pregnancy failure.

10. 4. Empty amnion Sign : Normal order of visibility of structures is yolk sac  embryo  Amnion) B ut to see an amnion and no embryo is known as Empty Amnion Sign . DD : Two yolk sacs of Early MCDA twins Two circular structures are seen within the gestational sac, representing the yolk sac and amnion. No embryo is visible. Suspected Pregnancy Failure

11. 5. Expanded amnion sign : visualization of an embryo that is surrounded by an amnion and has no cardiac activity Yolk Sac Amnion CRL Embryo surrounded by Amnion. No heartbeat was detected within the embryo.

12. 6. Enlarged Yolk Sac : upper limit of normal yolk sac diameter in the early first trimester is approximately 4.5 mm when measured inner-to-inner and 6 mm when measured outer-to-outer high rate of pregnancy failure when the diameter of the yolk sac is more than 7 mm

13. RISK FACTORS FOR IMPENDING PREGNANCY FAILURE WHEN EMBRYONIC HEARTBEAT SEEN Slow Embryonic Heart Rate : At 6.0 to 6.2 weeks, CRL 1-4 mm, Slow - <90 bpm Borderline 90-99 bpm At 6.3 to 7.0 weeks, CRL 5-9 mm Slow - <110 bpm Borderline – 110-119 bpm Follow up Sonogram in 1-2 weeks when slow heart rate is noted.

14. 2 . Subchorionic Hematoma : an irregular hypoechoic space, crescent-shaped, around part of the gestational sac. has internal echoes and is separated from the fluid inside the gestational sac by a thick band of tissue. Subjective assessment Hematoma surrounds at least two thirds of the gestational sac Volume of hematoma ≥ 60 mL

15. 3. Small gestational sac size in relation to the embryo : MSD − CRL < 5 mm (or subjective assessment)

16. THANK YOU 