ULTRASOUND


OVERVIEW


The aim of this report is to investigate the role of ultrasound in detecting miscarriages. Diagnosis of a miscarriage starts with the patient


being referred to the early pregnancy assessment unit, having had, for example, vaginal bleeding. From this, a working diagnosis of a threatened miscarriage is made which will be investigated further. The initial investigation utilises ultrasound to


measure the fetus to ensure it is within normal parameters, has a fetal heartbeat (FH) and is growing as it should. However, Aballah et al2


state that the


parameters used differ completely and therefore this may lead to unsafe practice, resulting in inadvertent termination of wanted pregnancies. If the fetus does not apply to the ‘normal’ parameters then further investigation should be made into whether it is either a complete, incomplete or missed miscarriage, as this will determine the types of management that will be available for the patient to consider. An assessment can be made using 2D ultrasound and transvaginal (TV) scans to assess if the patient for example, has retained products within the uterus. However, TV scans are very invasive which result in many patients refusing TV scans and consequently can lead to them receiving an inconclusive result and further appointments3 Additional imaging may be used when diagnosing


.


miscarriages including 3D and colour Doppler ultrasound. However, their use in diagnosing miscarriages is not agreed upon by all authors, as they may cause damage to the fetus in the early stages of gestation.


EXPECTED OUTCOMES The conclusion anticipated from this report is that ultrasound will be the most vital imaging modality and method for detecting miscarriages including the use of TV scans.


WHAT IS MISCARRIAGE? WHY DOES IT HAPPEN? Miscarriage refers to the spontaneous passage of the products of conception prior to completion of 20 weeks gestational age4


. It can be a very distressing


experience, both for the patient and the sonographer. Patients enter the department expecting to see a perfectly healthy baby and unfortunately, this isn’t always the case5


. Women frequently present to the


ultrasound department with a threatened miscarriage having had vaginal bleeding, with or without lower abdominal pain6,7


.


An observation noted by the author, was that one of the opening questions of many of these women was ‘do you know why this has happened’. There are many reasons as to why a person has miscarried, nevertheless the cause cannot always be easily identified8


the Miscarriage Association9


 Figure 1: Transvaginal ultrasound scan of an intrauterine gestation sac containing an embryo of greater than 6mm with no visible cardiac activity, Bottomley and Bourne (2009).


. For example, one of the causes stated by might be that the patient


has antiphospholipid syndrome (commonly known as sticky blood syndrome), which many authors suggest can be associated with complications during pregnancy leading to miscarriage10,11


. However, a


more recent study conducted by Prima et al12 JUNE 2017


states


There are many reasons as to why a person has miscarried


19


that the overall contribution of this syndrome may be uncertain, as the miscarriage could also be influenced by other underlying pathology, such as hypertension.


PATHOLOGY Ordinarily, as observed by the author, the patient will attend their first trimester ultrasound scan, where they will receive an estimated due date (EDD) based upon the crown rump length (CRL). However, if a patient had been admitted early due to vaginal bleeding this could be used to determine if the pregnancy is viable. The study by Bottomley and Bourne13


states that in embryos


with a CRL of between 2mm to 4.9mm with no cardiac activity, there is a 91% rate of miscarriage and with associated bleeding and no cardiac activity there is an 100% rate of miscarriage (as shown in Figure 1).


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