Ultrasonograhpy in the evaluation of early pregnancy loss

Abstract

Backgrounds: Examination of the ultrasonographic findings of early pregnancy loss. Methods: 196 patients with early pregnancy loss who were detected between 6-12. Gestational age were evaluated by transvaginal sonography. Demographic characteristics and ultrasound findings were recorded. 

Results: Mean age of patients was 27.5 (14-41). 108 patients (55%) had bleeding especially in patients with incomplete abortions. 36 patients have smoking history. Pregnancy loss rate was reduced with the increase of gestational week. Yolk sac was not detected in 21 (32.3) of 65 aborted patients with an embryo in whom fetal heart beat couldn't be seen. Yolk sac shape was deformed in 11 (25%) patients. In 27 of 65 patients (41.5%), mean gestational sac diameter obtained to be small compared to CRL. Yolk sac couldn't be seen in 17 (65.4%) of 26 patients in whom embryo was not seen. Yolk sac was seen in 9 (34.6%) patients. İrregular shaped yolk sac was observed in one patient and in one patient hyperechoic band was seen. In the remaining 7 patients yolk sac were found to be in normal shape but in very different sizes. In ultrasonographic evaluation of 31 patients with complete abortus; endometrium thickness was lower than 10 mm in 6 (19.35%) patients and it was found to be between in 10-15 mm in 25 (80.65%) patients. In ultrasonographic evaluation of 74 patients with incomplete abortus; endometrium was irreguler in 49 (66.2%)patients and intracavitary heterogen tissue was observed in 25 (33.8%) patients. Conclusions: Transvaginal sonography is highly reliable in the diagnosis of early pregnancy loss. Early regression, irregular shape, hyperechoic appearance of the yolk sac and irregular shape, small gestational sac according to CRL are important ultrasonographic findings early pregnancy loss. In addition, yolk sac shape and size can be normal in an important part of early pregnancy loss. 

Keywords

• Abortion,First trimester,Ultrasonography

Erken gebelik kayıplarının değerlendirilmesinde ultrasonografi

Abstract

Amaç: Erken gebelik kayıplarının ultrasonografik bulgularının incelenmesi Metot: Erken gebelik kaybı saptanan 6-12. gebelik haftaları arasındaki 196 hasta transvajinal sonografi ile değerlendirildi. Hastaların demografik özellikleri ve ultrason bulguları kaydedildi. Bulgular: Hastaların yaş ortalaması 27.5 (14-41) idi. Özellikle inkomplet abortuslu hastalar olmak üzere 108 (%55) hastada vajinal kanama mevcuttu. 36 (%18.36) olguda sigara kullanımı öyküsü vardı. Gebelik haftası ilerledikçe gebelik kaybı oranı azalmış bulundu. Fetal kalp atımı olmaksızın görülebilir bir embriyoya sahip abortuslu 65 hastanın 21'inde (%32.3) yolk sac saptanmadı. 7 (%15.9) hastada yolk sac genişlemiş, 4 (%9) hastada oldukça küçük izlendi. 25 (%56.8) hastada ise yolk sac çapı normal sınırlar içerisinde bulundu. 8 (%18) hastada yolk sac hiperekojen band görünümde idi. 11 (%25) hastada yolk sac şekli deforme olmuş olarak görüldü. 65 hastanın 27'sinde (%41.5) ortalama gestasyonel kese çapı CRL'ye göre küçük saptandı. Embriyo izlenmeyen 26 hastadan 17'sinde (%65.4) yolk sac görülemedi. 9 (%34.6) hastada yolk sac izlendi. Bir hastada yolk sac irregüler şekilli ve bir hastada da hiperekojen band şaklinde izlendi. Geri kalan 7 hastada yolk sac normal şekilde fakat oldukça farklı boyutlarda bulundu. Komplet abortuslu 31 hastanın ultrason incelemesinde; 6 (%19.35) hastada endometrium kalınlığı <10 mm, 25 (%80.65) hastada endometrium kalınlığı 10-15 mm arasında idi. İnkomplet abortuslu 74 hastanın ultrason incelemesinde 49 (%66.2) hastada endometrium irregüler, 25 (%33.8) hastada intrakaviter heterojen doku varlığı saptandı. Sonuç: Transvajinal sonografi erken gebelik kayıplarının tanısında oldukça güvenilirdir. Erken gebelik kayıplarında yolk kesesinin erken regresyonu, şeklinin düzensiz ve hiperekojen görünümde olması, düzensiz ve CRL'ye göre küçük gebelik kesesinin olması önemli ultrasonografik bulgulardır. Bunun yanında erken gebelik kayıplarının önemli kısmında yolk sac normal şekil ve büyüklükte olabilmektedir

Keywords

• Abortus,Birinci trimester,Ultrasonografi

References

1. 1.Barri PN. Perdida embrionaria preimplantatioria. İn Carrera JM, Kurjak (eds), Medicina del embrion. Masson, Barcelona; 1997: pp 143-148. 2.Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril 2012;98(5):1103–11. 3.Liu Y, Liu Y, Zhang S, Chen H, Liu M, Zhang J. Etiology of spontaneous abortion before and after the demonstration of embryonic cardiac activity in women with recurrent spontaneous abortion. HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/25640713" \o "International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics." Int J Gynaecol Obstet 2015 doi: 10.1016/j.ijgo.2014.11.012. 4.Nyberg DA, Filly RA. Opinion. Predicting pregnancy failure in "empty" gestational sacs. Ultrasound Obstet Gynecol 2003;21(1):9–12. 5.Kratochwil A, Eisenhut L. The earliest detection of fetal heart activity by ultrasound. Geburtshilfe Frauenheilkd 1967;27(2):176-180. 6.Zeadna A, Son WY, Moon JH, Dahan MH. A comparison of biochemical pregnancy rates between women who underwent IVF and fertile controls who conceived spontaneously. Hum Reprod 2015 doi:10.1093/humrep/dev024 7.Alfredsson J. Incidence of spontaneous abortion following artificial insemination by donor. Int J Fertil 1988;33(4):241–5. 8.Kolstad HA, Bonde JP, Hjollund NH, Jensen TK, Henriksen TB, Ernst E et al. Menstrual cycle pattern and fertility; a prospective follow-up study of pregnancy and early embryonal loss in 295 couple who were planning their first pregnancy. Fertil Steril 1999;71(3):490–6. 9.Cho FN, Chen SN, Tai MH, Yang TL. The q u a l i t y and size of yolk sac in early pregnancy loss. Australian and New Zealand Journal of Obstetrics and Gynaecology 2006;46(5):413-8. 10.Makrydimas G, Sebire N, Lolis D, Vlassis N, Nicolaides KH. Fetal loss following ultrasound diagnosis of a live fetus at 6-10 weeks of gestation. Ultrasound Obstet Gynecol 2003;22(4):368-72. 11.Snijders RJ, Sebire NJ, Nicolaides KH. Maternal and gestational age specific risk for chromosomal defects. Fetal Diagn Ther 1995;10(6):356-67. 12.Lindsay DJ, Lovett IS, Lyons EA, Levi CS, Zheng XH, Holt SC et al. Yolk sac diameter and shape at endovaginal US: Predictors of pregnancy outcome in the first trimester. Radiology 1992;183(1):115-8. 13.Mara E, Foster GS. Spontaneous regresyon of a yolk sac assosiated with embryonic death. J Ultrasound Med 2000;19(9):655-6. 14. Harris RD, Vincent LM, Askin FB. Yolk sac calcification: a sonographic finding associatiated with intrauterine embryonic demise in the first trimester. Radiology 1988;166(1 Pt 1):109-10. 15. Burns ME, Kleeman E, Bruns DE. Vitamin Ddepentdent calcium-binding protein of mouse yolk sac. Biochemical and immunochemical properties and responses to 1,25-dihydroxycholecalciferol. J Biol Chem 1986;261(16):7485-90. 16.Jauniaux E, Johns J, Burton GJ. The role of ultrasound imaging in diagnosing and investigating early pregnancy failure. Ultrasound Obstet Gynecol 2005;25(6):613-24. 17.Cunningham DS, Bledsoe LD, Tichenor JR, Opsahl MS. Ultrasonographic characteristics of first trimester gestations in recurrent spontaneous aborters. J Reprod Med 1995;40(8):565-70. 18.Paspulati RM, Bhatt S, Nohur SG. Sonographic evaluation of first-trimester bleeding.Radiologic Clinics of North America 2004;42(2): 297-314.