Early Pregnancy Failure - Part 3
How important are "Suspicious" Findings of Early Pregnancy Failure?
How important are "Suspicious" Findings of Early Pregnancy Failure?
algorithm step 1: Is there an embryo and does it have a heart beat?
sonographic findings associated with poor outcome
- SUBCHORIONIC HEMATOMA
- What exactly is a subchorionic hematoma?
- In our opinion, all come from some degree of abruption (i.e. separation of the placenta from the sac)
- This causes blood to accumulate in the endometrial cavity
- What is the most important factor with regard to subchorionic hematomas?
- Size is certainly important: larger is worse
- More important is location.... the degree to which it involves the placental attachment. More placental attachment "lifted off" = worse outcome
- What exactly is a subchorionic hematoma?
- SUSTAINED BRADYCARDIA
- Embryonic HR < 80 bpm
- SAC SIZE
- Both sac size "too big" or "too small" are negative prognostic indicators
- MSD - CRL < 5 MM has the worse prognosis
- ENLARGED YOLK SAC
- YS diameter > 7 mm
so what can we do with all of this information
- The consensus panel lists these as SUSPICIOUS but not definite for embryonic demise
- So, the reality is:
- We can't really use these because identification of a heart beat OVERRIDES all of these features!
- We must continue to follow these embyos and can only mention that some negative prognostic indicators are present