0:00

Right.

0:01

So we discussed the embryo

0:03

and its relation as far as size to pregnancy failure

0:06

and pregnancy of uncertain viability.

0:08

Let's talk about the gestational sec,

0:11

which is a slightly more complicated, but still pretty easy.

0:15

So we diagnose a demise

0:20

or a pregnancy failure by seeing an empty gestational sack

0:24

of a certain size.

0:26

We need to remember that this sack cannot have a yolk sack,

0:31

it cannot have an amnion,

0:32

and obviously it doesn't have an embryo,

0:34

or that would've shunted us back into measuring the embryo.

0:38

As with the embryo criteria, we used

0:41

to have different criteria for this, which

0:44

was any empty sac over 16 millimeters was

0:48

definitive for demise.

0:50

Um, and I don't, I don't mention these older measurements

0:53

to add confusion,

0:54

but I do wanna give you some historical context

0:57

and also help you to realize

0:58

that we were fine using those numbers.

1:01

Um, so these new numbers are even more stringent,

1:05

so we can feel pretty darn comfortable, um,

1:08

when using these newer, more conservative numbers

1:12

that we are truly dealing with a pregnancy failure.

1:16

So now the, the newer number, and again, 10 years old,

1:19

but at the time of this lecture, we've moved to a empty sac,

1:25

greater than 25 millimeters.

1:27

And I, I will tell you, a,

1:28

a sac greater than 25 millimeters is pretty huge.

1:31

So if it's empty, it's no doubt about it, it's a demise.

1:36

So here is a sack, it's empty.

1:40

On our cine clip, we see no yolk sack.

1:43

We see no amnion, we see no embryo

1:46

gestational sac measures.

1:48

37 millimeters is the mean sac diameter. That's it.

1:53

That's how we can diagnose early pregnancy failure using the

1:57

gestational sac on an initial study.

2:01

It's pretty darn simple.

2:04

This is a definitive pregnancy failure.

2:08

Now what about this pregnancy of uncertain viability?

2:11

We also have this. So what if we see a sack

2:14

that is empty again, that's less than 25 millimeters.

2:19

We cannot call it a demise.

2:21

So we call that a pregnancy of uncertain viability.

2:25

If we see a sack with a yolk sack of any size,

2:29

we're also gonna call it a pregnancy of uncertain viability.

2:34

So let's look in an example.

2:37

We have a sac, which is an int uterine pregnancy.

2:41

There is nothing in it.

2:45

There's no embryo, no yolk sac.

2:47

It measures less than 25 millimeters.

2:50

In fact, it only measures 4.5 millimeters.

2:54

So boom, this is a pregnancy of uncertain viability,

2:59

And we're done.

3:01

Here's another example. Here's a sac. It's empty.

3:05

There's no yolk sac. There's no embryo, there's no amnion.

3:09

The mean sac diameter here is 15.

3:15

That's less than 25. This isn't hard.

3:18

It's a pregnancy of uncertain viability.