Early transvaginal ultrasound following an accurately dated pregnancy: the importance of finding a yolk sac or fetal heart motion |
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Authors: | Deaton JL; Honore GM; Huffman CS; Bauguess P |
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Institution: | Department of Obstetrics and Gynecology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157, USA. |
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Abstract: | Our goals were to determine the prognostic value of a yolk sac or fetal
heart motion seen during an early accurately dated transvaginal ultrasound
(TVU). We reviewed 225 consecutive pregnancies for fetal heart motion data.
Furthermore, 63 pregnancies following in-vitro fertilization were reviewed
for yolk sac information. The TVU was performed between 5 and 6 weeks
following presumed conception (heart motion data) and between 22 and 32
days following in-vitro fertilization (yolk sac data). Pregnancies were
followed until an ongoing pregnancy or spontaneous abortion was documented.
The presence of a yolk sac between 22 and 32 days from fertilization was
associated with the development of fetal heart motion in 94% of cases. The
absence of the yolk sac by 32 days after fertilization was always
associated with a poor outcome. In women < 36 years of age, the presence
of fetal heart motion was associated with a spontaneous abortion in only
4.5% of the cases. However, the incidence of spontaneous abortion following
fetal heart motion increased to 10% in women 36-39 years and 29% in women
> or = 40 years of age. The presence of heart motion should not be
considered a reassuring sign in the older woman. These data have
implications regarding early embryology and the counselling of infertility
patients.
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