Accuracy of first‐trimester ultrasound in the diagnosis of early embryonic demise: a systematic review

Abstract

ObjectivesTo evaluate, by systematic review of the literature, the accuracy of first-trimester ultrasound in diagnosing early embryonic demise. MethodsWe searched MEDLINE (1951-2011), Embase (1980-2011

Misoprostol treatment vs expectant management in women with early non‐viable pregnancy and vaginal bleeding: a pragmatic randomized controlled trial

“…Because of new recommendations for ultrasound criteria of early pregnancy failure [5][6][7] , we changed our ultrasound criteria of non-viability in 2014. Before 2014 the criteria of non-viability in our study were one of the following: (1) intrauterine gestational sac with a mean diameter > 16 mm with no embryonic pole 20 or (2) a gestational sac with an embryo with CRL ≥ 5 mm without cardiac pulsations 20 , or (3) if the above criteria were not fulfilled, a gestational sac with or without an embryo that showed no significant development at a repeat scan after 7 days 20 .…”

Rationalising the change in defining non‐viability in the first trimester

“…, 9 – 11 Jeve, et al published a systematic review on the accuracy of first trimester ultrasound to make a diagnosis of miscarriage 9 . The authors found only eight papers of acceptable quality for analysis; six of them were prospective and two were retrospective cohort studies.…”

“…However as confidence intervals for both thresholds lied between 0.96–1.00, this would mean that up to four in every 100 diagnoses may be a false positive one. That is to say, for every 100 tests among women with an intra‐uterine pregnancy where these criteria would be used to define non‐viability, there might be up to four live pregnancies 9 . An important factor influencing these findings was the relatively small sample size of the studies analysed.…”

“…They defined miscarriage on the basis of an empty sac with a MSD ≥ 16 mm, or, if present, an embryo with a CRL measuring > 5 mm with no observable cardiac activity In Australia, the Australian Society of Ultrasound in Medicine (ASUM) had similar recommendations for MSD and CRL diagnostic criteria as the RCOG in the UK 8 6 , 9 – 11 the RCOG published an amendment to its 2006 guideline in October 2011 12 . ASUM followed suit in November 2011 and then the American College of Radiology in 2012 13 …”

Diamond ring sign

“…1) [1]. The yolk sac represents the ''ring'' and the embryo represents the ''diamond'' in this earliest sign of embryonic development [2,3].…”