Diagnostic criteria for nonviable pregnancy early in the first trimester.

Determining the viability of a pregnancy is a major challenge, especially with a pregnancy of unknown location. This review provides specific guidance, including stringent criteria for nonviability, that can reduce the risk of inadvertent harm to a potentially normal pregnancy.

[1]  D Timmerman,et al.  Gestational sac and embryonic growth are not useful as criteria to define miscarriage: a multicenter observational study , 2011, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[2]  D. J. Lindsay,et al.  Decidual cyst: endovaginal sonographic sign of ectopic pregnancy. , 1993, Radiology.

[3]  T. Tongsong,et al.  Transvaginal ultrasound in threatened abortions with empty gestational sacs , 1994, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[4]  D. J. Lindsay,et al.  Early diagnosis of nonviable pregnancy with endovaginal US. , 1988, Radiology.

[5]  R. Kurzel,et al.  Serum beta-hCG titers do not predict ruptured ectopic pregnancy. , 2006, International journal of fertility and women's medicine.

[6]  P. Doubilet,et al.  First, Do No Harm . . . to Early Pregnancies , 2010, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[7]  C. Berg,et al.  Trends in Ectopic Pregnancy Mortality in the United States: 1980–2007 , 2011, Obstetrics and gynecology.

[8]  S. Mace,et al.  Clinical policy: Critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy. , 2012, Annals of emergency medicine.

[9]  G. Koren,et al.  Outcome following high-dose methotrexate in pregnancies misdiagnosed as ectopic. , 2011, American journal of obstetrics and gynecology.

[10]  K. Barnhart.  Early pregnancy failure: beware of the pitfalls of modern management. , 2012, Fertility and sterility.

[11]  S. Thangaratinam,et al.  Accuracy of first‐trimester ultrasound in the diagnosis of early embryonic demise: a systematic review , 2011, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[12]  R. Filly,et al.  The double sac sign of early intrauterine pregnancy: use in exclusion of ectopic pregnancy. , 1982, Radiology.

[13]  T. Bourne,et al.  The hCG ratio can predict the ultimate viability of the intrauterine pregnancies of uncertain viability in the pregnancy of unknown location population. , 2008, Human reproduction.

[14]  T. Bourne,et al.  Limitations of current definitions of miscarriage using mean gestational sac diameter and crown–rump length measurements: a multicenter observational study , 2011, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[15]  B. Thilaganathan,et al.  The evidence base for miscarriage diagnosis: better late than never , 2011, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[16]  S. Goldstein.  Significance of Cardiac Activity on Endovaginal Ultrasound in Very Early Embryos , 1992, Obstetrics and gynecology.

[17]  D. Brown,et al.  Diagnosis of early embryonic demise by endovaginal sonography. , 1990, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[18]  S Van Huffel,et al.  Prediction of ectopic pregnancy in women with a pregnancy of unknown location , 2007, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[19]  D. Savitz,et al.  Comparison of pregnancy dating by last menstrual period, ultrasound scanning, and their combination. , 2002, American journal of obstetrics and gynecology.

[20]  R. Romero,et al.  Discriminatory hCG Zone: Its Use in the Sonographic Evaluation for Ectopic Pregnancy , 1981, Obstetrics and gynecology.

[21]  S Van Huffel,et al.  Rationalizing the follow-up of pregnancies of unknown location. , 2007, Human reproduction.

[22]  K. Barnhart.  Clinical practice. Ectopic pregnancy. , 2009, The New England journal of medicine.

[23]  Charles E. Mueller.  Intrauterine pseudogestational sac in ectopic pregnancy , 1979, Journal of clinical ultrasound : JCU.

[24]  K. Barnhart,et al.  Utility of dilation and curettage in the diagnosis of pregnancy of unknown location. , 2011, American journal of obstetrics and gynecology.

[25]  E. Mendelson,et al.  Transvaginal sonography in the evaluation of normal early pregnancy: correlation with HCG level. , 1989, AJR. American journal of roentgenology.

[26]  T. Bourne,et al.  Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location , 2005, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[27]  M. Deutchman,et al.  First trimester bleeding. , 2009, American family physician.

[28]  B. Goldberg,et al.  Prospective comparison of vaginal and abdominal sonography in normal early pregnancy. , 1991, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[29]  C. Moore,et al.  Ultrasound in pregnancy. , 2004, Emergency medicine clinics of North America.

[30]  Barry B. Goldberg,et al.  Diagnostic ultrasound : a logical approach , 1998 .

[31]  J. Shwayder.  Waiting for the tide to change: reducing risk in the turbulent sea of liability. , 2010, Obstetrics and gynecology.

[32]  K. Mohamed,et al.  Pregnancy of unknown location: an evidence‐based approach to management , 2008 .

[33]  D. Levine,et al.  Treatment of ectopic pregnancy: is a human chorionic gonadotropin level of 2,000 mIU/mL a reasonable threshold? , 1997, Radiology.

[34]  J. Rabinowitz,et al.  Intradecidual sign: a US criterion of early intrauterine pregnancy. , 1986, Radiology.

[35]  S. Van Huffel,et al.  Clinical implications of intra‐ and interobserver reproducibility of transvaginal sonographic measurement of gestational sac and crown–rump length at 6–9 weeks' gestation , 2011, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[36]  R. Filly,et al.  Further observations on the empty “amnion sign” , 2010, Journal of Clinical Ultrasound.

[37]  P. Doubilet,et al.  Further Evidence Against the Reliability of the Human Chorionic Gonadotropin Discriminatory Level , 2011, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[38]  P. Doubilet,et al.  Double Sac Sign and Intradecidual Sign in Early Pregnancy , 2013, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[39]  H. Wolfe,et al.  Reevaluation of Discriminatory and Threshold Levels for Serum &bgr;-hCG in Early Pregnancy , 2013, Obstetrics and gynecology.

[40]  G. Bernaschek,et al.  Vaginal sonography versus serum human chorionic gonadotropin in early detection of pregnancy. , 1988, American journal of obstetrics and gynecology.

[41]  E. Paldi,et al.  Evaluation of Normal Gestational Sac Growth: Appearance of Embryonic Heartbeat and Embryo Body Movements Using the Transvaginal Technique , 1991, Obstetrics and gynecology.

[42]  C. Benson,et al.  Intrauterine Fluid With Ectopic Pregnancy , 2013, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[43]  D. J. Lindsay,et al.  Endovaginal US: demonstration of cardiac activity in embryos of less than 5.0 mm in crown-rump length. , 1990, Radiology.

[44]  R. Felder,et al.  Vaginal Sonography Findings and hCG Dynamics of Early Intrauterine and Tubal Pregnancies , 1990, Obstetrics and gynecology.

[45]  S. Adhikari,et al.  Diagnosis and management of ectopic pregnancy using bedside transvaginal ultrasonography in the ED: a 2-year experience. , 2007, The American journal of emergency medicine.

[46]  Van Voorhis,et al.  AIUM practice guideline for the performance of pelvic ultrasound examinations. , 2010, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[47]  H. Nisenbaum,et al.  First-trimester US parameters of failed pregnancy. , 1997, Radiology.

[48]  P Doubilet,et al.  A Mathematical Approach to Interpretation and Selection of Diagnostic Tests , 1983, Medical decision making : an international journal of the Society for Medical Decision Making.

[49]  J. Hamilton.  OC04.01: The 6 mm crown–rump length threshold for detecting fetal heart movements—what is the evidence? , 2011 .

[50]  J. Hughes,et al.  First Do No Harm: Adverse Effects of Grouping Deviant Youth for Skills Training , 1999 .

[51]  Dirk Timmerman,et al.  Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. , 2011, Fertility and sterility.