by
Loren Bonner, DOTmed News Online Editor | October 10, 2013
Unfortunately, complications of early pregnancy that result in miscarriage or ectopic pregnancy are more frequent than most people realize.
How certain are physicians when they tell a woman that her pregnancy has no chance of proceeding? A panel led by a multidisciplinary team of experts from radiology, obstetrics-gynecology and emergency medicine are recommending the option of more stringent criteria for diagnosing serious first trimester pregnancy problems, including miscarriage and ectopic pregnancy.
These experts have recommended an updated set of criteria for use of ultrasonography in determining when a first trimester pregnancy has no chance of progressing into a live-born baby. These new diagnostic thresholds were published today in the New England Journal of Medicine.
"Protecting women and developing babies in early pregnancy was really a key goal of our paper and panel," said Dr. Peter Doubilet of Brigham and Women's Hospital and the report's lead author. "We feel adherence to our recommendations would not only improve patient care but also avoid inadvertent harm to normal pregnancies."
In the 1980s and 1990s, doctors developed rules for diagnosing miscarriages and ectopic pregnancies based on ultrasound and blood levels. But research in recent years shows that these rules are not foolproof and that they can lead to an incorrect diagnosis.
According to Doubilet, guidelines in their paper are designed to provide a level of certainty for physicians and patients. They recommend that ultrasound show an embryo measuring seven millimeters without a heartbeat to be diagnosed as nonviable. Before the standard was five millimeters. Similarly, the standard for nonviability based on the size of a gestational sac without an embryo should be raised from 16 to 25 millimeters. They also recommend excluding the blood test to determine a viable pregnancy.
"In the last two to three years with larger numbers of patients studied, they have seen that in some cases the embryo can be larger than five millimeters and can be 6 mm or even slightly over and have no heartbeat, and can be viable," said Doubilet. "That's why we realized the five millimeter criteria was not foolproof why we raised it to seven millimeters to provide certainty."
The same answer applies to raising the size of a gestational sac, said Doubilet.
The panel also cautioned physicians against taking any action that could damage an intrauterine pregnancy based on a single blood test, if the ultrasound findings are inconclusive and the woman is in stable condition.
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