Monday, February 27, 2012

Non viable pregnancy


  • 1-Patient’s symptoms:
  • -Asymptomatic.
  • -Brown vaginal staining or frank bleeding.
  • 2-Anembryonic miscarriage:
  • -Sac is seen without fetal node and fetal heart pulsation.
  • 3-Missed miscarriage:
  • -Sac  and embryo can be seen but with no pulsation.
  • 4-However , before considering a pregnancy non viable ,we should do trans-vaginal scan after trans-abdominal one and repeat the examination after one week or 10 days for re-evaluation.
  •  
    5- Ultrasound findings of non viable gestational sac.
    -Irregular outline.
    -Collapsed sac.
    -Hematoma formation.
    -Measures diameters in three dimensions and take the average. If the mean diameter is more than 20 mm and there is no evidence of an embryo or yolk sac, the appearance is highly suggestive of anembryonic miscarriage then , it is wise to obtain a second opinion by another scan 7 days latter for absolute confirmation unless clinical circumstances dictate otherwise.
     
    -If the embryo is seen , measure crown-rump length , if this is greater than 6 mm with no evidence of fetal heart pulsation , appearance is highly suggestive of missed miscarriage , then you should inform patient and repeat exam after 7 days as discussed before.
     D.D. of a gestational sac with no fetal node and no fetal heart pulsation (this could be )
     
    Points to remember:
    -A mean sac diameter more than 20 mm with no evidence of fetal pole or yolk sac is highly suggestive of anembryonic miscariage.
    -A CRL greater than 6mm with no evidence of a fetal heart pulsation is highly suggestive of missed miscarriage.
    -A repeat trans-vaginal scan after 7 days later should confirm diagnosis.
    Anembryonic miscarriage with evidence of a collapsed sac with diameter more than 20 mm and no evidence of fetal pole or yolk sac.

    Missed abortion characterized by presence of a fetal pole inside a fetal sac but without fetal heart pulsation

     This 1st trimester patient complained of pain in the lower abdomen. Sonography of the gravid uterus shows an anechoic collection (blood--> see arrows) in the upper part of the gestation sac between the decidual tissue and the chorion. There is also evidence of separation of the margins of the early placenta (abruption). The embryo, in this case, showed cardiac activity. These ultrasound images are diagnostic of sub chorionic hematoma. It is advisable to follow this case with repeat Sonography after 1 week and closely monitor the hematoma.

    This 1st trimester patient complained of pain in the lower abdomen. Sonography of the gravid uterus shows an anechoic collection (blood--> see arrows) in the upper part of the gestation sac between the decidual tissue and the chorion. There is also evidence of separation of the margins of the early placenta (abruption). The embryo, in this case, showed cardiac activity. These ultrasound images are diagnostic of sub chorionic hematoma. It is advisable to follow this case with repeat Sonography after 1 week and closely monitor the hematoma.

     Trans-vaginal sonogram . The absence of the gestational sac and the presence of intrauterine debris are typical of a incomplete abortion  with retained products.

    Abortion in progress in a patient with a history of vaginal bleeding. Transvaginal US image of the uterus demonstrates a low-lying gestational sac (arrow) with mixed hyper- and hypo echoic contents in the endometrial cavity of the fundus (arrowheads), which represent decidual reaction and hemorrhage. The patient experienced a complete spontaneous abortion a few hours after the US examination.

     

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