الفهرس 
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Abstract
Early pregnancy is now defined as the first 12 weeks of
pregnancy which was previously known as the first trimester of
pregnancy. Miscarriage is the most common complication of
pregnancy; it has been estimated that the overall miscarriage rate
is around 50%. Even though the majority of these losses occur
before a missed menstrual period, bleeding complicates about
20%-25% of clinically detected pregnancies and 12–15% are
lost.
Behind every normal human embryo stands the
combined contribution of the YS, the amnions, and the placenta.
The YS is a round fluid structure seen within the gestational sac.
The presence of a YS within the gestational sac is diagnostic of
an intrauterine pregnancy, but does not confirm viability. On
TVS, the YS is typically seen by approximately 5.5 weeks of
gestation and/or when the mean gestational sac diameter is ≥8
mm.
Assessment of the YS should be part of a complete firsttrimester
sonographic examination. An abnormality in the
sonographic appearance of YS can predict subsequent embryonic
death or abnormalities. Therefore, accurate recognition of the
normal and abnormal sonographic findings related to the YS can
be used to anticipate the course of pregnancy
The advent of high-resolution ultrasound imaging has
enabled the anatomy and physiology of the human fetal adnexae
to be studied in vivo from as early as the third week
postimplantation forward. Specially, TVS, with its ability to
provide accurate invivo images of the early gestational sac, has
also provided necessary evidence to the epidemiology and
pathophysiology of the failure of pregnancy at an early age.
Ultrasound has not only changed the medical approach to spontaneous miscarriage but also the patient’s perception of
normal and abnormal fetal development in utero.
The aims of our study are to measure and describe the
patterns of YS abnormalities and to identify the relation between
these abnormalities and other early embryonic morphologic
abnormalities detected by TVS in cases of first trimester missed
miscarriage.
The study was carried out on 204 women (ages, 18-45
years) who had missed miscarriage with gestational age ≤11
weeks, diagnosed by TVS. Missed miscarriage pregnant females
were recruited from the ultrasound and fetal care unit,
Demerdash Hospital, Ain Shams University.
TVS was done for missed miscarriage patients.
Ultrasonographic findings of YS classified according to Kurjac
et al., (2008) into: diameter, shape, and ultrasonographic
appearance
Early embryonic morphological findings of conceptuses
were classified according to Poland’s classification in to GD1,
GD2, GD3 and GD4.Ultrasonographic findings of embryos and
YS of those 204 pregnancies were correlated.
We found a significant relation between each of the YS
diameter, shape and appearance with embryonic morphology in
missed miscarriage cases.
The relation between YS diameter and embryonic
morphology when normal YS was linked more frequently to
normal morphologic embryos (48.72%). Findings of absent YS
were seen in 45.10% of anembryonic gestations (GD1) and
0.00% of normal morphologic embryos. Likewise, findings of
too small YS were seen more frequently in 38.89% of GD4
embryos and 37.04% of GD3. Too large YS was associated with GD4 (31.67%) and normal morphologic embryos (30.00%).
As regards of the relation between embryonic morphology
and YS shape, only 9 of the 153 cases who showed a YS had
irregular (abnormal) YS shape, yet the relation was significantly
related to GD4 and GD3.
As regards of the relation between embryonic
morphology and YS appearance, only 13 of the 153 cases who
showed a YS had hyperechoic (abnormal) YS appearance, yet the
relation was significantly related to GD3 and GD4.
Our study proved that in missed miscarriage cases, the
abnormalities in YS diameter were most common (80.88%)
while the abnormalities in YS shape and YS appearance were
uncommon (4.41% and 6.37%, respectively).
Our study was the first which described precisely
morphological features and YS findings in missed miscarriage
patients by TVS.