Obligatory medical device diagnostics.
- Vaginal sonography (ultrasound examination using an ultrasound probe inserted into the vagina (vagina)).
Sonography is performed for accurate diagnosis of abortion or disturbed early pregnancy (early pregnancy), as well as to exclude other intra-abdominal diseases (diseases of the abdominal organs). In addition to an exact determination of the gestational age and vital signs, it also allows indications for the development of the fruit as well as information on the cervical findings (cervical canal opened?, inner cervix closed?).
Indications of an emerging abortion include a slow fetal heart rate (less than 100 beats per minute) at 5-7 weeks gestation and subchorionic hemorrhage (bleeding between the placenta/uterine placenta and the wall of the uterus). Such a finding necessitates reexamination after 12 to 14 days until a definite characteristic is obtained.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnosis.
- Computed tomography (CT) of the abdomen (abdominal CT) – to exclude intra-abdominal diseases such as ileitis (inflammation of the lowest part of the small intestine, the ileum) or colitis (chronic inflammatory bowel disease (CED)).
Ultrasound criteria for abortion diagnosis
A. Ultrasound criteria for miscarriage that are suspicious but not confirmed.
- Crown-rump length (SSL) of ≤ 7 mm without cardiac action.
- Mean gestational sac diameter (GS diameter; fruiting sac diameter) of 16-24 mm mm without embryo.
- No embryo evidence with heartbeat ≥ 2 weeks after an examination showing a gestational sac without yolk sac* .
* The yolk sac performs metabolic functions until the liver is formed and is the source of stem cells for hematopoiesis (blood formation).
B. Diagnostic ultrasound criteria for abortion:
- Crown-rump length (SSL) of ≥ 7 mm without cardiac action.
- Mean gestational sac diameter (GS diameter; fruiting sac diameter) ≥ 25 mm without embryo.
- No embryo evidence with heartbeat 7-13 days after an examination showing a gestational sac without yolk sac.
- No embryo evidence with heartbeat 7-10 days after an examination that showed a gestational sac with a yolk sac.
- No embryo evidence ≥ 6 weeks after the last menstrual bleeding (menstrual period).
- Empty amnion (innermost amniotic sac surrounding the whole embryo) (no visible embryo; amnion seen next to yolk sac).
- Enlarged yolk sac (> 7 mm).
- Disproportion between gestational sac and embryo size, i.e., small gestational sac relative to embryo size (≤ 5 mm difference between mean gestational sac diameter and crown-rump length)
C. Reliable ultrasound criterion for complete expulsion.
- Documentation of a missing gestational sac in previously confirmed intrauterine pregnancy (pregnancy within the uterine cavity).
