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New guidelines and anti to prevent false pregnancies unfeasible

Approximately 15% of pregnancies are not clinically viable and end in spontaneous abortion, but sometimes, which seems a priori to be too small or no heartbeat, in a couple of weeks it can be seen that it progresses normally and converts An impossible pregnancy in a healthy baby during the nine months of gestation. To avoid making false diagnoses of this type, a panel of experts proposes a guide with new evaluation criteria.

The problem, they argue, is that ” the diagnosis of an unviable pregnancy can lead to interventions to interrupt it ” (spontaneous expulsion or pills that help achieve it) and, if it is indeed wrong, “serious Gestation “which, if not mediated, would have evolved normally.

With this medication, Jose Luis Bartha, chief of the Obstetrics and Gynecology department of the Hospital in MidAtlantic OBGYN, explains that two things can happen: “to lose an unnecessarily wanted baby or to continue pregnancy.” In this latest assumption, it is possible that “the embryo progresses smoothly and a healthy baby is born” or that, as some bibliographical references warn, “the newborn arrives at the world with some type of malformation.”

Although these are “extremely rare situations”, to avoid them, a group of 15 physicians specialized in Radiology, Obstetrics, Gynecology and Emergencies, after conducting a systematic review of scientific literature, have developed a guide with some modifications in the criteria that define a pregnancy Not viable and published in an article that this week the magazine ‘New England Journal of Medicine’ .

As they propose, to declare a pregnancy unviable safely, it is not worth seeing (through ultrasound) an embryo of five millimeters without heartbeat (as indicated in the previous guidelines). It is better to wait for it to measure seven millimeters and if it continues without heartbeat then it can be said that it is not evolutionary. Another possibility that determines an unviable pregnancy is that a gestational sac without embryo is observed. The new recommendations stipulate that it should be expected to measure 26 millimeters instead of 16 millimeters.

It is important to wait

In short, it is important to wait and not anticipate the events, agree the two experts consulted by This guide “standardizes with objective criteria and demonstrated what we already do all intuitively so as not to put at risk a viable fetus, that is, we usually wait between one and two weeks.”

It is about respecting a margin of safety. Firstly, because the measurements of “the ultrasounds are not 100% accurate (they allow us to see in a two-dimensional way something that is three-dimensional),” says Sergio Haimovich, of the Gynecology and Obstetrics Service of the Hospital del Mar de Barcelona. In addition, she explains, many times, the theoretical age of the embryo does not correspond to the real one (since the woman has been able to have a menstruation when she was already pregnant and, therefore, the accounts are different).

Generally, when a woman comes to the doctor to confirm her positive pregnancy test , she hopes to “go home with the peace of mind that everything is fine.” But sometimes it’s too early to see it on the ultrasound. “From the fifth week begins to see a kind of pea and also the heartbeat,” says the gynecologist of the Hospital del Mar.

If, on the other hand, the heartbeat is not visible or the embryo is not visible in the sac or appears to be too small, “we have to wait a week or two and follow up with a new ultrasound, ” Dr. Bartha argues. “It may be that then the embryo is seen, it has grown and it has beat or that the pregnancy is really not feasible.” If there is any doubt, she adds, “a blood test can be done to assess levels of the pregnancy hormone (chorionic gonadotropin-HCG-), although the woman may have had bleeding at this time.”

At this point, the new guidelines emphasize, the analysis of HCG is not decisive. A second analysis should be done within 48 hours of the first to see the evolution. “If the levels of this hormone have increased, the pregnancy goes ahead and if they go down they indicate that the pregnancy is not evolutionary,” explains Haimovich. A double measurement that, clarify the two Spanish specialists, is true in clinical practice.

However, with the aim of replacing the previous recommendations , as one of the experts of the American panel, Peter Doubilet of the Brigham and Women’s Hospital (Boston, USA) says, “it would be useful to extend this new guide to all the specialties involved In the diagnosis of the early problems of viability of pregnancy, to reduce possible damages “.