This video shows Missed abortion with fluid in cul de sac.
Missed Abortion
In routine practice, when there is a suspicion of a non‐viable pregnancy, we rely on the measurements of the CRL and gestational sac to make the diagnosis. The current guidelines state that:
If the crown-rump length (CRL) is more than 6 mm and there is no embryonic cardiac activity, this is defined as a missed miscarriage, or
If the mean gestational sac diameter is more than 20 mm and there is no yolk sac or embryonic pole, this is defined as an empty sac miscarriage, or
If at the follow-up scan after at least one week, there is still no embryonic cardiac activity or the gestational sac remains empty, then a diagnosis of non‐viability can be made.
Although a variety of terms are used to describe early pregnancy failure, in the presence of clear-cut sonographic evidence that a nonliving embryo is present, the term embryonic demise should apply.
In addition to signs of fetal life on sonography, subchorionic bleeding is an important factor affecting the outcome of gestations in patients with clinical threatened abortion. The most common cause for first-trimester spontaneous abortion is fetal chromosomal abnormalities.
While most practitioners wait until at least 6 weeks to perform the first ultrasound, a gestational sac can be seen as early as 4 1/2 weeks after your last period; a heartbeat can be detected as early as 5 to 6 weeks (though it might not be detected that early in all cases).
A Missed abortion is a Missed miscarriage in which the fetus didn't form or fetal demise had occurred, but the placenta and embryonic tissues are still in the uterus. It's known more commonly as a missed miscarriage. It's also sometimes called a Silent miscarriage. A missed abortion is not an elective abortion.
Missed miscarriage means that the baby has stopped growing or there is fetal demise but there are no miscarriage symptoms such as bleeding or pain. It can also be called a delayed miscarriage.
Some women do not experience any symptoms of miscarriage at all; however, possible miscarriage
Signs besides bleeding include:
Mild to severe cramps.
Pain in the back or abdomen.
Loss of pregnancy symptoms, such as nausea or vomiting.
White-pink mucus.
Passing tissue or clot-like material.
To make the diagnosis with ultrasound the findings may include, but not be limited to the absence of fetal pole, lack of growth of fetal pole, fetal pole with no evident cardiac activity, lack of yolk sac at the appropriate gestational age, de-shaped yolk sac or placental separation.
The umbilical cord forms by the fifth week of development, replacing the yolk sac as the source of nutrients for the embryo. The umbilical cord is a cord that connects the developing baby to the mother in utero. The umbilical cord attaches to the baby at the abdomen and to the mother at the placenta. The cord forms during the fifth week of gestation (seventh week of pregnancy).
Fluid in cul de sac
Pouch of Douglas is a deep peritoneal recess between the uterus and the upper vaginal wall anteriorly and the rectum posteriorly. - called also cul-de-sac, a cul-de-sac of Douglas, Douglas's cul-de-sac, Douglas's pouch.
The Pouch of Douglas (cul-de-sac or rectovaginal septum) is the space between the rectum and the uterus. This is the lowest part of the abdominal cavity.
A small amount of fluid in the cul-de-sac is normal and is usually not of concern. If the fluid sample shows signs of pus or blood, the area may need to be drained. Sometimes blood can be a result of a ruptured cyst or signs of an ectopic pregnancy.
Culdocentesis is a procedure that checks for abnormal fluid in the space just behind the vagina. This area is called the cul-de-sac. During a culdocentesis, a long thin needle is inserted through the vaginal wall just below the uterus and a sample is taken of the fluid within the abdominal cavity.
It is normal to have approximately 1 to 3 ml (or mL) of fluid in the recto-uterine pouch throughout the menstrual cycle. After ovulation, there is between 4 and 5 ml of fluid in the recto-uterine pouch.
The free fluid will be found in the pelvic cavity only in the pathological process of bleeding into the stomach, acute inflammation, or accumulation of fluid between abdominal adhesions that occurred on a surgical or inflammatory background.
Menstrual blood that has refluxed through the fallopian tubes and fluids related to ovulation or ruptured cysts settle in it. Likewise, blood from a ruptured ectopic pregnancy, inflammatory debris from a pelvic or appendiceal infection, and ascites due to malignancy, liver, or cardiac failure may collect here.