New consensus-based guidance allows better determination of location and viability of pregnancy.
Transvaginal ultrasound (TVUS) and serial measurement of serum human chorionic gonadotropin (hCG) have transformed the assessment of pregnant women with early pain and/or bleeding or with other risk factors for ectopic pregnancy (EP) or nonviable intrauterine pregnancy (IUP). With widespread use of these diagnostic modalities, clinicians in obstetrics and gynecology, radiology, emergency medicine, and primary care increasingly encounter early pregnancies of uncertain viability and unknown location — but interpreting the test results to determine appropriate interventions remains challenging. Accordingly, experts in radiology and obstetrics and gynecology have developed a consensus statement from the Society of Radiologists in Ultrasound based on current published data.
The panel states that definitive pregnancy failure can be diagnosed in a woman with an IUP of uncertain viability when TVUS reveals any of the following:
For evaluation and management of a woman with pregnancy of unknown location when TVUS reveals no intrauterine fluid and no obvious adnexal abnormalities:
For pregnant women in whom TVUS has not been performed: