Question 1 of 18

(demo test)

ANSWER:  Notify the referring physician of nonviable pregnancy

EXPLANATION:

The provided transvaginal ultrasound (US) images demonstrate a fetal pole with crown rump length (CRL) of 1.2 cm within an intrauterine gestational sac, without evidence of fetal heart tones.  Findings are compatible with failed/nonviable pregnancy. 

US findings found to be diagnostic of pregnancy failure include:  

• CRL >7mm without heartbeat
  
  
• Mean sac diameter (MSD)>25mm without visualization of the embryo
  
  
• Embryo without a identifiable heartbeat 2 or more weeks following prior US demonstrating gestational sac without yolk sac.

WRONG ANSWERS:

• Findings suspicious for pregnancy failure; repeat ultrasound in 2 weeks:  the US images provided demonstrate findings compatible with 1st trimester pregnancy failure.  No repeat US in 2 weeks is indicated.
  
  
• Continue routine US with serial beta-Hcg levels:  images provide do not indicate a live intrauterine pregnancy.
  
  
• Notify surgeon of live ectopic pregnancy:  there is no evidence that the gestational sac with fetal pole is in an ectopic location.
  
  
• Consult Ob-Gyn for findings suggestive of complete molar pregnancy:  complete molar pregnancy US findings include the multicystic appearance of “snowstorm” or “bunch of grapes”.

REFERENCE:

Rodgers SK, Chang C, DeBardeleben JT, Horrow MM. Normal and Abnormal US Findings in Early First-Trimester Pregnancy: Review of the Society of Radiologists in Ultrasound 2012 Consensus Panel Recommendations. Radiographics. 2015;35(7):2135-2148.