Determining the viability of early pregnancies
Case 1: A repeat ultrasound 6 days after the initial one revealed no change: a persistent empty gestational sac without a fetal pole.
The evidence pointed to an inevitable abortion [miscarriage]; however, the patient's stable condition and the clinician's skepticism about the available information prompted further waiting.
Two days later, the [beta]-HCG level was 29,000, and a third ultrasound 13 days after the original one demonstrated a viable intrauterine pregnancy corresponding to a fetal age of 8 weeks.
The patient subsequently gave birth to a normal male infant at term.
Case 2: At 7 2/7 weeks a pelvic ultrasound examination was obtained. It indicated a gestational sac of 22 mm mean diameter, which corresponded to an age of 7 weeks.
No fetal pole was visualized, however, and the possibility of a blighted ovum or an incomplete abortion [miscarriage] was raised. One week later the physical examination was unchanged.
The patient's [beta]-HCG level that day (8 2/7 weeks) was 123,000 mIU/mL; 48 hours later the level was 50,840 mIU/mL. The patient was informed of the significance of the results and advised to repeat the tests in 1 week.
The following week the patient's [beta]-HCG level was 710,000 mIU/mL, and a second ultrasound examination 2 1/2 weeks after the initial study demonstrated a viable 9 1/2-week fetus.
The patient gave birth to a normal female infant at 42 weeks.
Photo credit: Baby And Dad Sleeping
by Vera Kratochvil
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Category: embryo, HCG, Miscarriage, ultrasound
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