Early transvaginal ultrasound following an accurately dated pregnancy:: the importance of finding a yolk sac or fetal heart motion

Our goals were to determine the prognostic value of a yolk sac or fetal heart motion seen during an early accurately dated transvaginal ultrasound (TVU), We reviewed 225 consecutive pregnancies for fetal heart motion data, Furthermore, 63 pregnancies following in-vitro fertilization were reviewed for yolk sac information, The TVU was performed between 5 and 6 weeks following presumed conception (heart motion data) and between 22 and 32 days following in-vitro fertilization (yolk sac data). Pregnancies were followed until an ongoing pregnancy or spontaneous abortion was documented, The presence of a yolk sac between 22 and 32 days from fertilization was associated with the development of fetal heart motion in 94% of cases, The absence of the yolk sac by 32 days after fertilization was always associated with a poor outcome. In women <36 years of age, the presence of fetal heart motion was associated with a spontaneous abortion in only 3.5% of the cases, However, the incidence of spontaneous abortion following fetal heart motion increased to 10% in women 36-39 years and 29% in women greater than or equal to 40 years of age. The presence of heart motion should not be considered a reassuring sign in the older woman, These data have implications regarding early embryology and the counselling of infertility patients.