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

Department of Obstetrics and Gynaecology, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK.
Ultrasound in Obstetrics and Gynecology (Impact Factor: 3.56). 11/2011; 38(5):489-96. DOI: 10.1002/uog.10108
Source: PubMed

ABSTRACT To evaluate, by systematic review of the literature, the accuracy of first-trimester ultrasound in diagnosing early embryonic demise.
We searched MEDLINE (1951-2011), Embase (1980-2011) and the Cochrane Library (2010) for relevant citations. The reference lists of all known primary and review articles were examined. Language restrictions were not applied. Studies which evaluated the accuracy of first-trimester ultrasonography in pregnant women for the diagnosis of early embryonic demise were selected in a two-stage process and their data extracted by two reviewers. Accuracy measures including sensitivity, specificity and likelihood ratios (LRs) for abnormal and normal test results were calculated for each study and for each test threshold.
Eight primary articles with four test categories (18 2 × 2 tables), involving 872 women, evaluated the accuracy of ultrasound in diagnosing early embryonic demise. The lower limit of the 95% CI for specificity was > 0.95 in only two tests. These were an empty gestational sac with mean diameter of ≥ 25 mm and absent yolk sac with a mean gestational sac diameter of ≥ 20 mm (specificity, 1.00; 95% CI, 0.96-1.00 for both).
There is a paucity of high-quality, prospective data on which to base guidelines for the accurate diagnosis of early pregnancy demise. The findings are limited by the small number of studies and patients, the age of the studies, inclusion of symptomatic and asymptomatic women and variable reference standards for diagnosis of early pregnancy demise. Before guidelines for the safe management of threatened miscarriage can be formulated, there is an urgent need for an appropriately powered, prospective study using current ultrasound technology and an agreed reference standard for pregnancy success or loss.

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    ABSTRACT: Objectives-New early first-trimester diagnostic criteria for nonviable pregnancy recommended by the Society of Radiologists in Ultrasound via a multispecialty consensus panel extended the diagnostic size criteria of crown-rump length from S to 7 mm for embryos without a heartbeat and mean sac diameter from 16 to 25 mm for "empty" sacs. Our study assessed the potential impact of the new criteria on the number of additional follow-up sonograms these changes would engender. Methods-A retrospective study of all first-trimester sonograms in women with first trimester bleeding from 1999 to 2008 was conducted. Everyone included in the study had a visible gestational sac in the uterus. There were no pregnancies of unknown location or ectopic pregnancies included in this study cohort. Pregnancy of unknown location was used to describe cases in which there were no signs of pregnancy inside or outside the uterus on transvaginal sonography despite a positive pregnancy test result A total of 1013 patients met the inclusion criteria. Results-Seven hundred fifty-two patients (74%) had identifiable embryos, and 261 (26%) did not. Of those with an identifiable embryo, 286 (38%) had no detectable embryonic cardiac activity. The breakdown of crown-rump lengths in this group was as follows: 100 measuring less than 5 mm, 36 measuring 5 to 7 mm, and 150 measuring 7 mm or greater. The breakdown of mean sac diameters in those without a visible embryo was as follows: 120 measuring less than 16 mm, 90 measuring 16 to 25 mm, and 51 measuring 25 mm or greater. Conclusions-When diagnosing a failed pregnancy, there can be no room for error. Only 126 of 1013 early pregnancies threatening to abort (12%) fell into the more conservative zones defined by the new compared to the former size criteria (crown-rump length, 5-7 mm; mean sac diameter, 16-25 mm). Therefore, the potential impact of the new guidelines on follow-up sonograms does not appear inordinate.
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    ABSTRACT: Bleeding and pain are experienced by 20% of women during the first trimester of pregnancy. Although most pregnancies complicated by pain and bleeding tend to progress normally, these symptoms are distressing for woman, and they are also associated with an increased risk of miscarriage and ectopic pregnancy. Ultrasound is the first and often the only diagnostic modality that is used to determine location of early pregnancy and to assess its health. Ultrasound is an accurate, safe, painless and relatively inexpensive diagnostic tool, which all contributed to its widespread use in early pregnancy. Pain and bleeding in early pregnancy are sometimes caused by concomitant gynaecological, gastrointestinal, and urological problems, which could also be detected on ultrasound scan. In women with suspected intra-abdominal bleeding, ultrasound scan can be used to detect the presence of blood and provide information about the extent of bleeding. In this chapter, we comprehensively review the use of ultrasound in the diagnosis and management of early pregnancy complications. We include information about the diagnosis of gynaecological and other pelvic abnormalities, which could cause pain or bleeding in pregnancy. We also provide a summary of the current views on the safety of ultrasound in early pregnancy.
    Bailli&egrave re s Best Practice and Research in Clinical Obstetrics and Gynaecology 07/2014; DOI:10.1016/j.bpobgyn.2014.04.003 · 3.00 Impact Factor

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