PREVIOUSLY PUBLISHED ARTICLE
Diagnostic Criteria for Nonviable Pregnancy Early in the First Trimester Peter M. Doubilet, MD, PhD,* Carol B. Benson, MD,* Tom Bourne, MB, BS, PhD,Þ Michael Blaivas, MDþ for the Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy§ Key Words: early pregnancy failure, ectopic pregnancy, pregnancy of unknown location (Ultrasound Quarterly 2014;30:3Y9)
O
ver the past two to three decades, pelvic ultrasonography and measurements of the serum concentration of human chorionic gonadotropin (hCG) [Table 1] have become mainstays in the diagnosis and management of early pregnancy problems. These tests, which allow earlier detection of pregnancy and more accurate diagnosis of its complications than were previously possible, have revolutionized the management of intrauterine pregnancies and markedly reduced the morbidity and mortality associated with ectopic pregnancy.1,2 While these tests have indisputable benefits, their misuse and misinterpretation can lead to interventions that inadvertently damage pregnancies that might have had normal outcomes.3,4 There are well-documented instances of women with intrauterine pregnancies treated with intramuscular methotrexate for Received for publication November 14, 2013; accepted November 19, 2013. *Brigham and Women’s Hospital and Harvard Medical School; †Queen Charlotte’s and Chelsea Hospital, Imperial College, London, UK; and ‡University of South Carolina. The authors declare no conflict of interest. §Kurt T. Barnhart, M.D., M.S.C.E., Perelman School of Medicine at the University of Pennsylvania, Beryl R. Benacerraf, M.D., Brigham and Women’s Hospital and Harvard Medical School, Douglas L. Brown, M.D., Mayo Clinic Rochester, Roy A. Filly, M.D., University of California San Francisco, J. Christian Fox, M.D., University of California Irvine, Steven R. Goldstein, M.D., New York University School of Medicine, John L. Kendall, M.D., Denver Health Medical Center, Edward A. Lyons, M.D., Health Sciences Center, University of Manitoba, Misty Blanchette Porter, M.D., The Geisel School of Medicine at Dartmouth, Dolores H. Pretorius, M.D., University of California San Diego, Ilan E. Timor-Tritsch, M.D., New York University School of Medicine. From New England Journal of Medicine, Doubilet PM, Benson CB, Bourne T, Blaivas M; Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy, Barnhart KT, Benacerraf BR, Brown DL, Filly RA, Fox JC, Goldstein SR, Kendall JL, Lyons EA, Porter MB, Pretorius DH, Timor-Tritsch IE, Diagnostic criteria for nonviable pregnancy early in the first trimester, vol. 369, pp. 1443Y1451. Copyright * (2013) Massachussets Medical Society. Reprinted with permission. Disclaimer: Tom Bourne is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Reprints: Peter M. Doubilet, MD, PhD, Brigham and Women’s Hospital and Harvard Medical School (e
Diagnostic Criteria for Nonviable Pregnancy Early in the First Trimester Peter M. Doubilet, MD, PhD,* Carol B. Benson, MD,* Tom Bourne, MB, BS, PhD,Þ Michael Blaivas, MDþ for the Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy§ Key Words: early pregnancy failure, ectopic pregnancy, pregnancy of unknown location (Ultrasound Quarterly 2014;30:3Y9)
O
ver the past two to three decades, pelvic ultrasonography and measurements of the serum concentration of human chorionic gonadotropin (hCG) [Table 1] have become mainstays in the diagnosis and management of early pregnancy problems. These tests, which allow earlier detection of pregnancy and more accurate diagnosis of its complications than were previously possible, have revolutionized the management of intrauterine pregnancies and markedly reduced the morbidity and mortality associated with ectopic pregnancy.1,2 While these tests have indisputable benefits, their misuse and misinterpretation can lead to interventions that inadvertently damage pregnancies that might have had normal outcomes.3,4 There are well-documented instances of women with intrauterine pregnancies treated with intramuscular methotrexate for Received for publication November 14, 2013; accepted November 19, 2013. *Brigham and Women’s Hospital and Harvard Medical School; †Queen Charlotte’s and Chelsea Hospital, Imperial College, London, UK; and ‡University of South Carolina. The authors declare no conflict of interest. §Kurt T. Barnhart, M.D., M.S.C.E., Perelman School of Medicine at the University of Pennsylvania, Beryl R. Benacerraf, M.D., Brigham and Women’s Hospital and Harvard Medical School, Douglas L. Brown, M.D., Mayo Clinic Rochester, Roy A. Filly, M.D., University of California San Francisco, J. Christian Fox, M.D., University of California Irvine, Steven R. Goldstein, M.D., New York University School of Medicine, John L. Kendall, M.D., Denver Health Medical Center, Edward A. Lyons, M.D., Health Sciences Center, University of Manitoba, Misty Blanchette Porter, M.D., The Geisel School of Medicine at Dartmouth, Dolores H. Pretorius, M.D., University of California San Diego, Ilan E. Timor-Tritsch, M.D., New York University School of Medicine. From New England Journal of Medicine, Doubilet PM, Benson CB, Bourne T, Blaivas M; Society of Radiologists in Ultrasound Multispecialty Panel on Early First Trimester Diagnosis of Miscarriage and Exclusion of a Viable Intrauterine Pregnancy, Barnhart KT, Benacerraf BR, Brown DL, Filly RA, Fox JC, Goldstein SR, Kendall JL, Lyons EA, Porter MB, Pretorius DH, Timor-Tritsch IE, Diagnostic criteria for nonviable pregnancy early in the first trimester, vol. 369, pp. 1443Y1451. Copyright * (2013) Massachussets Medical Society. Reprinted with permission. Disclaimer: Tom Bourne is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Reprints: Peter M. Doubilet, MD, PhD, Brigham and Women’s Hospital and Harvard Medical School (e
