A gestational sac
with a foetal pole without cardiac activity.
Ultrasound features PHM, % CHM, % IM, % p-value Snowstorm appearance 5.7 89.3 100 0.005 Cystic placental 31.4 0.0 0.0 0.004 changes with fetus or IUGS * Cystic placental 28.6 3.6 0.0 0.084 changes without fetus or IUGS Features of missed 34.3 7.1 0.0 0.003 miscarriage GTD: gestational trophoblastic disease; PHM: partial hydatidiform mole; CHM: complete hydatidiform mole; IM: invasive mole; IUGS: intrauterine gestational sac
Ultrasound guided aspiration of the gestational sac
content has been used as a minimally invasive approach (8).
have reported a similar case of a 35-year-old patient admitted to the hospital because of severe abdominal pain with positive [beta]hCG and no intrauterine gestational sac
visualized on ultra-sonography.
Color Doppler US can help differentiate lower uterine-segment implantation from a gestational sac
of a failed pregnancy in the process of expulsion by demonstrating loss of circumferential blood flow in the failed pregnancy.
Under general anesthesia, a 17-gauge single lumen follicle aspiration needle was inserted into the lateral fornix and passed through the myometrium directly into the gestational sac
under transvaginal guidance under sterile conditions.
The primary outcome was a gestational sac
expulsion by the time of this follow-up, and no additional surgical or medical intervention within 30 days.
The paucity of the myometrium around the gestational sac
is diagnostic of interstitial pregnancy, while an angular pregnancy has at least 5 mm of myometrium on all its sides ; in the first case the embryo is implanted lateral to the round ligament and in the second one embryo is implanted in the lateral angle of the uterine cavity, medial to the uterotubal junction and round ligament .
Sagittal and axial T1- and T2-weighted images demonstrated a gestational sac
bulging through the myometrium of the lower uterine segment in the region of Cesarean section scar (Figure 4).
(7) defined the diagnostic criteria for cesarean scar EP as follows: a) Empty uterine cavity and cervix; b) Thinning of the myometrial layer between the bladder and gestational sac
; c) Determination of peritrophoblastic perfusion around the gestational sac
using Doppler sonography; d) Non-changing position of the gestational sac
after gentle pressure from a transvaginal ultrasound probe (7).
The second criterion was the presence of gestational sac
(implantation) that was assessed by vaginal ultrasonography (Honda 2000) at 6-7 weeks of pregnancy and finally the last but not least criterion was clinical pregnancy that was defined as the confirmed detection of fetal heart rate (FHR).
Three months later, the gestational sac
was measured and it was undetectable by ultrasound 6 months later (Dei Malatesta et al.