Failed early pregnancy

Failed early pregnancy refers to the death of the embryo and therefore, miscarriage. The most common cause of embryonic death is a chromosomal abnormality.

  • crown-rump length (CRL) of ≥7 mm and no heartbeat on a transvaginal scan
  • mean sac diameter (MSD) of ≥25 mm and no embryo on a transvaginal scan
  • absence of embryo with heartbeat ≥2 weeks after a scan that showed a gestational sac without a yolk sac
  • absence of embryo with heartbeat ≥11 days after a scan that showed a gestational sac with a yolk sac
  • pregnancy with an embryo with no heart activity on initial scan and repeat scan ≥7 days later 2
  • sac with no embryo and an MSD <12 mm on initial scan that fails to double in size on a scan ≥14 days later 2
  • sac with no embryo and an MSD ≥12 mm on initial scan with no embryo heart activity on a scan ≥7 days later 2
  • embryo (irrespective of crown-rump length) without cardiac activity on initial scan and a scan ≥7 days later 2
  • crown-rump length (CRL) of <7 mm and no heartbeat
  • mean sac diameter (MSD) of 16-24 mm and no embryo
  • absence of embryo with heartbeat 7-13 days after a scan that showed a gestational sac without a yolk sac
  • absence of embryo with heartbeat 7-10 days after a scan that showed a gestational sac with a yolk sac
  • absence of embryo ≥6 weeks after last menstrual period
  • amnion seen adjacent to yolk sac, with no visible embryo (empty amnion sign)
  • enlarged yolk sac (>7 mm)
  • small gestational sac in relation to the size of the embryo (<5 mm difference between mean sac diameter and crown-rump length)
  • large amniotic cavity (expanded amnion sign)

When there are findings suspicious for pregnancy failure, follow-up ultrasonography at 7-14 days to assess the pregnancy for viability is generally appropriate.

Ultrasound - obstetric
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Article information

rID: 9040
System: Obstetrics
Section: Gamuts
Synonyms or Alternate Spellings:
  • Embryonal death
  • Embryonic death
  • Embryonic demise
  • Embryonal demise
  • Non-viable early pregnancy
  • Failed early gestation
  • Non viable early gestation

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Cases and figures

  • Case 1: with absent fetal heart beat
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  • Case 2
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  • Case 3
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