Dooley, WM; De Braud, L; Thanatsis, N; Memtsa, M; Jauniaux, E; Jurkovic, D; (2021) Predictive value of presence of amniotic sac without visible embryonic heartbeat in diagnosis of early embryonic demise. Ultrasound in Obstetrics & Gynecology , 57 (1) pp. 149-154. 10.1002/uog.23533.

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Abstract

OBJECTIVES: This study aimed to assess the diagnostic value and impact on management of early embryonic demise of visualising an amniotic sac without a live embryo on ultrasound imaging. We also examined the potential effect this finding would have on the rate of follow up visits in early pregnancy units if incorporated into current diagnostic algorithms. METHODS: This was a prospective cohort study assessing all pregnant women who attended a single specialist early pregnancy unit from July 2017 to November 2018 with symptoms of pain and/or bleeding, or with a history of ectopic pregnancy or miscarriage, at less than 14 weeks' gestation. The detailed initial ultrasound findings were documented including whether an amniotic sac was present in normally sited intrauterine pregnancies in the absence of a live embryo. Women were followed-up until a conclusive diagnosis was made. RESULTS: The study included 6012 women attending with early pregnancy complications during the study period. A conclusive diagnosis was reached on the initial scan in 4221 (70.2%), whilst 1135 (18.9%) had pregnancies of uncertain viability and 656 (10.9%) had pregnancies of unknown location. All women with pregnancies of uncertain viability required follow up ultrasound scans to differentiate between live pregnancies and early embryonic demise. An amniotic sac in the absence of a live embryo was found in 174/1135 (15.3%) of women with pregnancies of uncertain viability at their initial ultrasound scan. In all cases the diagnosis of early embryonic demise was confirmed in all 134 of these women who attended their follow-up scans. The presence of amniotic sac without live embryo at the initial visit had a specificity of 100% (95% CI 98.53-100.00) and positive predictive value of 100% CI 87.37-88.24) in the diagnosis of early embryonic demise. A total of 1403/6012 (23.3%) women were asked to attend for follow-up ultrasound scans to resolve diagnostic uncertainties. 268/656 (40.9%) women with PUL required follow up scans, so the majority of follow up scans needed to reach a conclusive diagnosis were in women with pregnancies of uncertain viability (1135/1403 (80.1%)). By using the presence of amniotic sac without a live embryo to diagnose miscarriage at the initial visit the number of follow-up scans for pregnancies of uncertain viability would be reduced by 14.4% which accounted for 11% of all follow up scans during the study period. CONCLUSIONS: Our study showed that the finding of an amniotic sac without a live embryo on ultrasound ('amniotic sac sign') is a reliable marker of early pregnancy failure and could reduce the number of follow-up scans by 11% in cases of diagnostic uncertainty. This article is protected by copyright. All rights reserved.

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