Page 102 - PCC05

Addendum to GTG No 25 (Oct 2006): The Management of Early Pregnancy Loss
• Recent research suggests that given inter‐observer variability in ultrasound measurements and the greater variation in early embryonic growth than has hitherto been assumed, a more conservative approach to the diagnosis of early pregnancy loss is warranted.
• The studies from Imperial College London, Queen Mary, University of London and the KU Leuven, Belgium published in the November 2011 issue of Ultrasound Obstet Gynaecol concluded that current definitions used to diagnose miscarriage could lead to an incorrect diagnosis and they call for clearer evidence based guidance on detecting miscarriage. Having carefully considered these papers, we recommend adoption of the following
interim guidance with immediate effect:
Addendum to GTG No 25 (Oct 2006): The Management of Early Pregnancy Loss
• Ultrasound diagnosis of miscarriage should only be considered with a mean gestation sac diameter >/= 25mm (with no obvious yolk sac),
or with a fetal pole with crown rump length >/=7mm (without evidence of fetal heart activity)
• A TVS should be performed in all cases where there is any doubt about the diagnosis and/or a woman requests a repeat scan, this should be performed at an interval of at least one week from the initial scan before medical or surgical measures are undertaken for uterine evacuation. No growth in gestation sac size
or CRL is strongly suggestive of a non‐viable pregnancy in the absence of embryonic structures.
Page 96 of 135
102