• Three-dimensional sonographic volumetry of the gestational sac and the amniotic sac in the first trimester. Odeh M, Hirsh Y, Degani S, Grinin V, Ofir E, Bornstein J. J Ultrasound Med. 2008 Mar;27(3):373-8. PMID: 18314515

Early (34-56 days from last menstrual period) ultrasonographic measurements in normal pregnancies.

Hum Reprod. 1996 Aug;11(8):1771-4.

Coulam CB, Britten S, Soenksen DM.

Genetics & IVF Institute, Fairfax, VA 22031, USA. Abstract To assess early embryonic growth and development, 361 pregnancies were studied from 34 to 56 days from last menstrual period. All pregnancies had a subsequent successful outcome. Transvaginal ultrasonography was performed using an Acuson 128 x P/10 with a 5-7.5 MHz probe. Gestational sac diameter, embryonic pole length and embryonic heart rates were measured. Embryonic heart rates were determined by M-mode. Gestational sac diameter, embryonic pole length and embryonic heart rate increased linearly relative to gestational age and to each other. Regression equations comparing gestational sac diameter and embryonic pole length as well as comparing embryonic heart rate with gestational sac diameter and embryonic pole length were constructed. To be normal, gestations that have (i) sac diameter of 20 mm and 30 mm should contain at least a 2 mm and 5 mm embryo with embryonic heart rates of at least 75 and 100 beats per min, respectively, and (ii) embryos measuring 2 mm, 5 mm, 10 mm and 15 mm should display embryonic heart rates of at least 75, 100, 120 and 130 beats per minute respectively.

PMID: 8921130 [PubMed - indexed for MEDLINE]

Structural anomalies in early embryonic death: a 3-dimensional pictorial essay.

J Ultrasound Med. 2010 Mar;29(3):445-53. Bromley B, Shipp TD, Benacerraf BR.

Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. bbsono@aol.com Abstract OBJECTIVE: The purpose of this pictorial essay was to determine whether 3-dimensional (3D) surface rendering of a dead first-trimester embryo can provide any information for the loss. METHODS: Three-dimensional surface rendering was performed on a collection of dead first-trimester embryos with crown-rump lengths between 12 and 27 mm. These were compared with 2-dimensional (2D) images of the same embryos and with 2D images and 3D surface renderings of normally developing embryos. RESULTS: Surface rendering of dead embryos showed a variety of abnormalities in the contour and limb formation. CONCLUSIONS: The use of 3D sonography may provide insight into the etiology of first-trimester embryonic death.

PMID: 20194939

Further observations on the empty "amnion sign".

J Clin Ultrasound. 2010 Mar-Apr;38(3):113-7. Yegul NT, Filly RA.

Department of Radiology, University of California, San Francisco, L374, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA. Abstract OBJECTIVE: To assess the positive predictive value of the empty "amnion sign" (visualization of an amnion without concomitant visualization of an embryo) for the diagnosis of early pregnancy failure. METHODS: Retrospective study of 882 1st trimester sonographic examinations with abnormal findings among women who were threatening to abort. Eight hundred six met the inclusion criteria. RESULTS: In the study cohort 286 (35.5%) had no identifiable embryo and 71 of those without an identifiable embryo had a visible amnion (24.8%). The breakdown of the mean sac diameter of the study cohort was as follows: those measuring less than 16 mm (n = 16); those measuring 16-20 mm (n = 20); those measuring 21 mm or more (n = 35). Sixty-eight of the 71 patients had adequate follow-up. Pregnancy failure was confirmed in all 68 patients (positive predictive value = 100%). CONCLUSIONS: The data from this study indicate that visualization of an amnion without concomitant visualization of an embryo (the empty "amnion sign") confirms pregnancy failure regardless of the mean sac diameter and with a sufficiently high positive predictive value to make a definitive diagnosis. Copyright 2010 Wiley Periodicals, Inc.

PMID: 20127965

Embryonic death in early pregnancy: a new look at the first trimester.

Obstet Gynecol. 1994 Aug;84(2):294-7. Goldstein SR.

Department of Obstetrics and Gynecology, New York University School of Medicine, New York. Abstract OBJECTIVE: To examine the frequency of pregnancy loss following successful development of anatomical embryonic landmarks identified with endovaginal ultrasound. METHODS: Two hundred thirty-two women with positive urinary pregnancy tests and no antecedent history of vaginal bleeding had endovaginal sonography performed at the initial visit and at subsequent visits as indicated clinically. The presence of anatomical and embryonic structures (gestational sac, yolk sac, embryo) and cardiac activity was recorded. Patients were followed until delivery unless sonographic evidence of nonviability was seen or spontaneous loss occurred. RESULTS: Twenty-seven losses occurred during the embryonic period, four losses occurred in the fetal period, and there were 201 live births. If a gestational sac developed, subsequent loss of viability in the embryonic period occurred in 11.5%; loss rates were 8.5% with a yolk sac, 7.2% for an embryo up to 5 mm, 3.3% for an embryo of 6-10 mm, and 0.5% for an embryo larger than 10 mm. No pregnancies were lost between 8.5 and 14 menstrual weeks. The fetal loss rate after 14 weeks was 2.0%. CONCLUSIONS: The rate of early pregnancy loss decreases successively with gestational age and is virtually complete by the end of the embryonic period (70 days after onset of the last menstrual period). Subsequent pregnancy losses in the fetal period occur between 14 and 20 weeks. This pattern of early pregnancy death suggests a period of embryonic loss distinct from one of fetal loss. Based on these data, the physiologic significance of the traditional boundary of the first trimester as an appropriate dividing time line for early pregnancy may be questioned.

PMID: 8041550 [PubMed - indexed for MEDLINE]