Diagnostic Methods of Ectopic Pregnancy and Early Pregnancy Loss: a Review of the Literature

Abstract

This review article presents recent evidence on early pregnancy loss and ectopic pregnancy. In the light of recent evidence, the β-hCG discriminatory zone may be extended in clinically stable cases without evidence of bleeding. A possible cut-off is 4300 mIU/ml, which corresponds to when a sonographer should detect an intrauterine pregnancy. Embryonic demise can be confirmed when a transvaginal ultrasound finding shows no heartbeat in an embryo of more than 7 mm CRL, no embryo in a gestational sac having a mean sac diameter of more than 25 mm, or no appearance of an embryo within 7–10 days after the primary examination. These are considered definitive signs of embryonic demise. Suggestive signs of embryonic demise require closer monitoring of the pregnancy.

Zusammenfassung

Der vorliegende Übersichtsartikel gibt einen Überblick über die neuesten Forschungsergebnisse zu Frühabort und Extrauteringravidität. Nach den neuesten Forschungsergebnissen könnte der Referenzbereich für β-hCG-Werte in klinisch stabilen Patientinnen ohne Blutungen ausgedehnt werden. Als möglicher Cut-off-Wert wird ein Wert von 4300 mIU/ml diskutiert, welcher ungefähr dem Zeitpunkt entspricht, an dem die Schwangerschaft auch per Ultraschall festzustellen sein sollte. Ultraschall kann zur Bestätigung eines Frühaborts dienen, wenn sich bei einem Embryo mit einer SSL von mehr als 7 mm keine Herztätigkeit feststellen lässt, bzw. sich kein Embryo in einer Fruchtblase mit einem durchschnittlichen Durchmesser von mehr als 25 mm befindet, oder wenn kein Embryo innerhalb von 7–10 Tagen nach der Erstuntersuchung aufzufinden ist. Diese Befunde sind allesamt als definitive Hinweise auf einen embryonalen Tod zu werten. Bei Anzeichen, die auf einen Frühabort hindeuten, ist eine engmaschige Überwachung der Patientin notwendig.

Key words

early pregnancy loss - fetal demise - ectopic pregnancy - β-hCG - ultrasound

Schlüsselwörter

Frühabort - Fruchttod - Extrauteringravidität - β-hCG - Ultraschall

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