Faculty Bibliography

The aim of this retrospetive study was to identify any consistent patterns between ultrasound findings in failed pregnancies and either normal or abnormal karyotypes. The study involved 102 women in whom the diagnosis of early pregnancy failure was made sonographically. The criteria for a failed pregnancy were: a gestational sac with a mean diameter of > 12 mm without a yolk sac; a yolk sac of > 6 mm mean diameter with or without abnormal morphology that ultimately failed to develop an embryonic structure; and an embryo with a crown--rump length (CRL) of > 5 mm without cardiac activity, or the loss of previously identified cardiac activity. All patients underwent elective dilatation and curettage (D & C) and products of conception were sent for karyotyping. Forty-four pregnancies (43%) had abnormal karyotypes. Of these, 33 (75%) were trisomies. The other 11 included four triploidies, one tetraploidy, two with monosomy X, and four others (unbalanced complement, isochromosome, terminal deletion and translocation). Fifty-eight pregnancies (57%) had normal karyotypes, of which 52 were 46,XX and six were 46,XY. The furthest sonographic anatomic landmark achieved did not differ with respect to karyotypic findings. An abnormal yolk sac was found in 10/58 cases (17.2%) with normal karyotypes and 8/44 cases (18.2%) with abnormal karyotypes. There were eight cases of trisomy 16, of which only two manifested an embryonic structure, but neither of which had cardiac activity; the largest was 4 mm. There were four cases of trisomy 22, of which three developed embryos with a CRL of > 10 mm with cardiac activity (11, 11 and 18 mm, respectively). In three cases of mosaicism, embryos developed cardiac activity, and were 9, 19 and 16 mm. Two cases of monosomy X had embryos of 14 and 24 mm. Only one out of five cases with multiple trisomies developed to a point at which any embryonic structure was identifiable on ultrasound examination. The ultrasound appearance of early pregnancy failure in terms of furthest anatomic landmark reached was not significantly different in cases with normal or abnormal karyotype. An abnormally enlarged yolk sac, presumably secondary to hydropic change, is a non-specific finding of failed pregnancy, and did not correlate with karyotypic abnormality (trisomy 22, mosaic, monosomy X) seem to develop further prior to embryonic demise than those with certain others (trisomy 16, multiple trisomies and unusual other variants

Saline infusion sonography enhances endovaginal ultrasound examination of the uterine cavity. It is easily and rapidly performed at minimal cost. It is well tolerated by patients and virtually devoid of complications. It can prevent further invasive diagnostic procedures in some patients and optimize the preoperative triage process for those patients who will require therapeutic intervention

Early pregnancy can be best divided into embryonic and fetal periods (dividing line 70 days after last menstrual period), which more naturally reflect developmental changes, morphologic appearance, loss rates, and concerns about teratogens. Newer endovaginal probes and a better understanding of anatomic landmarks and expected growth rates can improve clinical management and patient counseling