Caution is advised in the diagnosis of embryonic demise. Determination of whether the viewed structure is the embryo is critical, as no other morphologically recognizable structures, other than a heartbeat, exist at this stage of development. The embryo must be scanned thoroughly for evidence of a heartbeat. Most recommendations call for 2 independent examiners to view the embryo, either concurrent with the ED visit or at follow-up. Most sonographers recommend repeating the scan within 3-7 days to determine if normal development is occurring.
Subchorionic hemorrhage encompasses a spectrum of sonographic findings.
Subchorionic fluid can be classified in relation to gestational sac size and length of gestation. Subchorionic bleeding is present when pulsation of the subchorionic fluid is noted. Size of the subchorionic hemorrhage should be taken into consideration, as greater size relates to an increased risk of spontaneous abortion. Subchorionic bleeding can be demonstrated using color Doppler imaging. Endovaginal ultrasound should be applied whenever possible to limit image distortion due to patient habitus or an overdistended bladder.