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Pregnancy of Unknown Viability

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Ultrasound Imaging in Reproductive Medicine

Abstract

Bleeding in early pregnancy complicates 15 % of all conceptions and accounts for nearly 2 % of all emergency department visits. Seventy to ninety percent of these pregnancies will progress normally. The remainder will either spontaneously abort or be an ectopic pregnancy. With advances in technology, the ability to detect pregnancy at earlier gestational age, either biochemically or sonographically, provides both diagnostic assistance and challenge to practitioners. One of the more clinically challenging scenarios is the patient with a positive pregnancy test who presents with uterine bleeding or pelvic pain and whose fetus cannot be located by ultrasound. An astute clinician must always have concern for a life-threatening ectopic pregnancy or miscarriage. When the situation is uncertain, the clinician must decide if the patient has signs and symptoms highly concerning for abnormal pregnancy. This is important to avoid erroneous treatments or counseling which could not only harm a viable fetus but also may lead to significant medical legal risk. The uncertainty of diagnosis and management is especially true when physicians from multiple disciplines with different skill sets converge in the emergency department. The goal of this chapter is to clarify for the practitioner the evaluation and treatment of early pregnancy of unknown viability or location.

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Abbreviations

β-hCG:

Beta subunit of human chorionic gonadotropin

FHR:

Fetal heart rate

FP:

Fetal pole

GS:

Gestational sac

hCG:

Human chorionic gonadotropin

IPUV:

Intrauterine pregnancy of unknown viability

PUL:

Pregnancy of unknown location

SAB:

Spontaneous abortion

YS:

Yolk sac

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Eastern Virginia Medical School, 825 Fairfax Avenue, Norfolk, VA, 23507, USA

    Emily N. B. Myer MD & Steven L. Warsof MD

  2. Maternal Fetal Medicine, Eastern Virginia Medical School, 2075 Glenn Mitchell Dr. #500, Virginia Beach, VA, 23456, USA

    Jane Arrington RDMS

Authors
  1. Emily N. B. Myer MD
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  2. Jane Arrington RDMS
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  3. Steven L. Warsof MD
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Corresponding author

Correspondence to Steven L. Warsof MD .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, Eastern Virginia Medical School Jones Institute for Reproductive Medicine, Norfolk, Virginia, USA

    Laurel Stadtmauer

  2. Institute for Human Reproduction, Chicago, Illinois, USA

    Ilan Tur-Kaspa

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Myer, E.N.B., Arrington, J., Warsof, S.L. (2014). Pregnancy of Unknown Viability. In: Stadtmauer, L., Tur-Kaspa, I. (eds) Ultrasound Imaging in Reproductive Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9182-8_24

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  • DOI: https://doi.org/10.1007/978-1-4614-9182-8_24

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  • Online ISBN: 978-1-4614-9182-8

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