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  1. Article ; Online: Fourfold Improved Odds of a Good First Trimester Outcome Once a Yolk Sac Is Seen in Early Pregnancy.

    Doubilet, Peter M / Phillips, Catherine H / Durfee, Sara M / Benson, Carol B

    Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

    2022  Volume 41, Issue 11, Page(s) 2835–2840

    Abstract: ... with a yolk sac were live (P < .000001, chi-square). This corresponds to an odds ratio of 4.14 for the presence ... vaginal bleeding all carried an increased risk of loss (P < .000001, chi-square). Outcome was better ... with a visualized yolk sac than without a yolk sac, regardless of number of risk factors (P < .001, chi-square ...

    Abstract Objectives: To compare first trimester prognosis when an early pregnancy sonogram demonstrates a gestational sac with yolk sac versus gestational sac without yolk sac.
    Methods: Our study comprised 823 transvaginal sonograms without identifiable embryo performed at least 35 days from last menstrual period (LMP), in which mean sac diameter was <16 mm and first trimester outcome (live or early pregnancy loss) was known. We recorded the presence or absence of yolk sac, first trimester outcome, and several clinical features: maternal age, time since LMP, and presence or absence of vaginal bleeding. We compared the likelihood of a successful first trimester outcome in cases with a visible yolk sac to those without a yolk sac.
    Results: At the end of the first trimester, 113 of 270 (41.9%) cases without a yolk sac and 414 of 553 (74.9%) with a yolk sac were live (P < .000001, chi-square). This corresponds to an odds ratio of 4.14 for the presence of yolk sac, a result confirmed by logistic regression. Advanced maternal age, ≥42 days since LMP, and vaginal bleeding all carried an increased risk of loss (P < .000001, chi-square). Outcome was better with a visualized yolk sac than without a yolk sac, regardless of number of risk factors (P < .001, chi-square).
    Conclusions: The odds of successful first trimester outcome are 4-fold higher when a yolk sac is seen on an early pregnancy sonogram than when no yolk sac is seen. For any level of risk, based on maternal age, vaginal bleeding, and time since LMP, outcome is significantly better when a yolk sac is seen.
    MeSH term(s) Pregnancy ; Female ; Humans ; Infant ; Pregnancy Trimester, First ; Pregnancy Outcome ; Ultrasonography, Prenatal ; Prospective Studies ; Uterine Hemorrhage/diagnostic imaging
    Language English
    Publishing date 2022-02-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 604829-8
    ISSN 1550-9613 ; 0278-4297
    ISSN (online) 1550-9613
    ISSN 0278-4297
    DOI 10.1002/jum.15971
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  2. Article ; Online: First-Trimester Prognosis When an Early Gestational Sac is Seen on Ultrasound Imaging: Logistic Regression Prediction Model.

    Doubilet, Peter M / Phillips, Catherine H / Durfee, Sara M / Benson, Carol B

    Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

    2020  Volume 40, Issue 3, Page(s) 541–550

    Abstract: ... were significantly correlated with outcome (P < .05, t test for age and MSD, χ: Conclusions ...

    Abstract Objectives: To determine the factors that jointly and independently affect first-trimester outcome of very early intrauterine pregnancies (those whose sonogram shows a gestational sac with no identifiable yolk sac or embryo) and develop a mathematical model and Web-based calculator that computes prognosis based on these factors.
    Methods: Our study population included 590 very early pregnancies scanned between January 1, 2012, and June 30, 2018, with known outcomes (live or spontaneous loss) at 14 weeks. We recorded patient age, mean sac diameter (MSD), human chorionic gonadotropin (hCG) rise, and presence/absence of: vaginal bleeding, history of infertility, prior miscarriage, and pregnancy via assisted reproductive technology. We assessed the correlation between each of these factors and outcome and performed stepwise logistic regression to determine the subset that independently correlated with outcome.
    Results: Patient age, MSD, hCG rise, vaginal bleeding, history of infertility, and assisted reproductive technology pregnancy were significantly correlated with outcome (P < .05, t test for age and MSD, χ
    Conclusions: The prognosis of very early intrauterine pregnancies is related to several clinical, biochemical, and sonographic factors. The factors that independently correlate with first-trimester outcome are patient age, MSD, hCG rise, and vaginal bleeding. The logistic regression model predicts outcome based on these variables.
    MeSH term(s) Abortion, Spontaneous ; Female ; Gestational Sac/diagnostic imaging ; Humans ; Logistic Models ; Pregnancy ; Pregnancy Trimester, First ; Prognosis ; Ultrasonography, Prenatal
    Language English
    Publishing date 2020-08-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 604829-8
    ISSN 1550-9613 ; 0278-4297
    ISSN (online) 1550-9613
    ISSN 0278-4297
    DOI 10.1002/jum.15430
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  3. Article ; Online: "Pseudogestational Sac" and Other 1980s-Era Concepts in Early First-Trimester Ultrasound: Are They Still Relevant Today?

    Phillips, Catherine H / Benson, Carol B / Durfee, Sara M / Heller, Howard T / Doubilet, Peter M

    Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

    2020  Volume 39, Issue 8, Page(s) 1547–1551

    Abstract: ... to without, an IDS (P = .01, χ: Conclusions: In a woman with positive human chorionic gonadotropin results and no ...

    Abstract Objectives: To determine whether an intrauterine round or oval fluid collection ("saclike structure") can prove to be either an intrauterine pregnancy or intrauterine fluid in conjunction with an ectopic pregnancy (sometimes termed "pseudogestational sac") and whether ultrasound features, including the presence or absence of an echogenic rim, "double sac sign" (DSS), or "intradecidual sign" (IDS), are helpful for establishing the diagnosis or predicting the prognosis.
    Methods: We identified all sonograms obtained from women with positive serum human chorionic gonadotropin results at our institution between January 1, 2012, and June 30, 2018, meeting the following criteria: presence of an intrauterine saclike structure without a yolk sac or embryo; no extraovarian adnexal mass; and follow-up information identifying the location of the pregnancy as intrauterine or ectopic. Study authors reviewed sonograms in all cases and recorded the following information: presence or absence of each of an echogenic rim around the collection, a DSS, and an IDS, as well as the mean sac diameter. The indications for the initial ultrasound examinations were recorded.
    Results: A total of 649 sonograms met the inclusion criteria. Of these, 598 fluid collections showed an echogenic rim, 182 a DSS, and 347 an IDS (findings not mutually exclusive). In all 649 cases, a subsequent sonogram or other clinical follow-up confirmed that the patient had an intrauterine pregnancy. That is, none of the fluid collections proved to be a pseudogestational sac. In total, 41.2% were live at the end of the first trimester, and 58.8% miscarried. The prognosis was better in cases with, compared to without, an IDS (P = .01, χ
    Conclusions: In a woman with positive human chorionic gonadotropin results and no extraovarian adnexal mass, the ultrasound finding of an intrauterine saclike structure is virtually certain to be a gestational sac. Ultrasound features of the structure are of no diagnostic or clinically useful prognostic value. Concepts introduced 30 to 40 years ago when ultrasound equipment had far lower resolution than currently, including a DDS, an IDS, and a pseudogestational sac, have no role today in assessing early pregnancy.
    MeSH term(s) Female ; Gestational Sac/diagnostic imaging ; Humans ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy, Ectopic/diagnostic imaging ; Ultrasonography ; Yolk Sac/diagnostic imaging
    Language English
    Publishing date 2020-02-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 604829-8
    ISSN 1550-9613 ; 0278-4297
    ISSN (online) 1550-9613
    ISSN 0278-4297
    DOI 10.1002/jum.15243
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  4. Article ; Online: Double sac sign and intradecidual sign in early pregnancy: interobserver reliability and frequency of occurrence.

    Doubilet, Peter M / Benson, Carol B

    Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

    2013  Volume 32, Issue 7, Page(s) 1207–1214

    Abstract: ... P > .05, t test, all comparisons). An inner echogenic ring was present in 158 cases (79.4%), and ... to the presence of a DSS or an IDS, presence of an inner echogenic ring, or decidual appearance (P > .05, χ(2 ...

    Abstract Objectives: To assess the interobserver agreement, frequency of occurrence, and prognostic importance of the double sac sign (DSS), intradecidual sign (IDS), and other sonographic findings in early intrauterine pregnancies.
    Methods: We retrospectively identified all sonograms obtained between January 1, 2006, and December 31, 2011, in which: (1) the scan demonstrated an intrauterine fluid collection without a yolk sac or embryo; (2) a follow-up scan confirmed an intrauterine pregnancy; and (3) the first-trimester outcome was known. Each coinvestigator characterized the 199 study sonograms as demonstrating or not demonstrating a DSS or an IDS, based on judgment about whether the scan met published criteria defining these signs.
    Results: Interobserver agreement was poor for the DSS (κ= 0.24) and IDS (κ= 0.23). Scans frequently demonstrated neither sign: 150 cases (75.4%) if we considered a sign to be present when both investigators graded it as present and 69 cases (34.7%) using the looser criterion that either graded it as present. The presence of a DSS or an IDS was unrelated to the β-human chorionic gonadotropin (β-hCG) value (P > .05, t test, all comparisons). An inner echogenic ring was present in 158 cases (79.4%), and the decidua was brighter peripherally than centrally in 102 (51.3%). The first-trimester outcome was unrelated to the presence of a DSS or an IDS, presence of an inner echogenic ring, or decidual appearance (P > .05, χ(2), all comparisons).
    Conclusions: The sonographic appearance of early gestational sacs, before visualization of a yolk sac or embryo, is highly variable. The DSS and IDS are often absent; there is poor interobserver agreement regarding these signs; and the prognosis is unrelated to their presence or absence. A round or oval intrauterine fluid collection in a woman with positive β-hCG should be treated as a gestational sac until proven otherwise, regardless of whether it demonstrates a DSS or an IDS.
    MeSH term(s) Adult ; Boston/epidemiology ; Female ; Gestational Sac/diagnostic imaging ; Humans ; Incidence ; Observer Variation ; Pregnancy ; Pregnancy Rate ; Pregnancy Tests/methods ; Pregnancy Tests/statistics & numerical data ; Reproducibility of Results ; Risk Factors ; Sensitivity and Specificity ; Ultrasonography, Prenatal/methods ; Ultrasonography, Prenatal/statistics & numerical data
    Language English
    Publishing date 2013-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 604829-8
    ISSN 1550-9613 ; 0278-4297
    ISSN (online) 1550-9613
    ISSN 0278-4297
    DOI 10.7863/ultra.32.7.1207
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  5. Article: Society of Radiologists in Ultrasound Consensus Conference statement on postmenopausal bleeding.

    Doubilet, P M

    Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

    2001  Volume 20, Issue 10, Page(s) 1037–1042

    MeSH term(s) Biopsy/economics ; Consensus Development Conferences as Topic ; Endometrial Neoplasms/diagnostic imaging ; Endometrium/diagnostic imaging ; Estrogen Replacement Therapy ; Female ; Humans ; Hysteroscopy ; Postmenopause/physiology ; Practice Guidelines as Topic ; Radiology ; Societies, Medical ; Ultrasonography ; Uterine Hemorrhage/diagnostic imaging ; Uterine Hemorrhage/etiology
    Language English
    Publishing date 2001-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 604829-8
    ISSN 1550-9613 ; 0278-4297
    ISSN (online) 1550-9613
    ISSN 0278-4297
    DOI 10.7863/jum.2001.20.10.1037
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  6. Article ; Online: Further evidence against the reliability of the human chorionic gonadotropin discriminatory level.

    Doubilet, Peter M / Benson, Carol B

    Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

    2011  Volume 30, Issue 12, Page(s) 1637–1642

    Abstract: ... final pregnancy outcome (P > .05, logistic regression analysis and Fisher exact test). The highest β-hCG ...

    Abstract Objectives: The human chorionic gonadotropin (hCG) discriminatory level-the maternal serum β-hCG level above which a gestational sac should be consistently visible on sonography in a normal pregnancy--has been reported to be 1000 to 2000 mIU/mL for transvaginal sonography. We assessed whether a woman with a β-hCG above 2000 mIU/mL and no intrauterine fluid collection on transvaginal sonography can subsequently be found to have a live intrauterine gestation and, if so, what the prognosis is for the pregnancy.
    Methods: We identified all women scanned between January 1, 2000, and December 31, 2010, who met the following criteria: serum β-hCG testing and transvaginal sonography were performed on the same day; β-hCG was positive and sonography showed no intrauterine fluid collection; and a live intrauterine pregnancy was subsequently documented. We tabulated the β-hCG levels in these cases and assessed pregnancy outcome.
    Results: A total of 202 patients met the inclusion criteria, including 162 (80.2%) who had β-hCG levels below 1000 mIU/mL on the day of the initial scan showing no intrauterine fluid collection, 19 (9.4%) with levels of 1000 to 1499, 12 (5.9%) 1500 to 1999, and 9 (4.5%) above 2000 mIU/mL. There was no significant relationship between initial β-hCG level and either first-trimester outcome or final pregnancy outcome (P > .05, logistic regression analysis and Fisher exact test). The highest β-hCG was 6567 mIU/mL, and the highest value that preceded a liveborn term baby was 4336 mIU/mL.
    Conclusions: The hCG discriminatory level should not be used to determine the management of a hemodynamically stable patient with suspected ectopic pregnancy, if sonography demonstrates no findings of intrauterine or ectopic pregnancy.
    MeSH term(s) Adult ; Boston/epidemiology ; Chorionic Gonadotropin/blood ; Evidence-Based Medicine ; Female ; Humans ; Male ; Pregnancy/blood ; Reproducibility of Results ; Sensitivity and Specificity ; Ultrasonography, Prenatal/methods ; Ultrasonography, Prenatal/statistics & numerical data ; Yolk Sac/diagnostic imaging
    Chemical Substances Chorionic Gonadotropin
    Language English
    Publishing date 2011-11-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 604829-8
    ISSN 1550-9613 ; 0278-4297
    ISSN (online) 1550-9613
    ISSN 0278-4297
    DOI 10.7863/jum.2011.30.12.1637
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  7. Article: Transvaginal sonography versus transabdominal pelvic sonography.

    Doubilet, P M

    AJR. American journal of roentgenology

    1999  Volume 173, Issue 3, Page(s) 846

    MeSH term(s) Female ; Genital Diseases, Female/diagnostic imaging ; Humans ; Ultrasonography/methods
    Language English
    Publishing date 1999-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 82076-3
    ISSN 1546-3141 ; 0361-803X ; 0092-5381
    ISSN (online) 1546-3141
    ISSN 0361-803X ; 0092-5381
    DOI 10.2214/ajr.173.3.10470949
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  8. Article ; Online: Subchorionic Hematoma: Correlation of Grading Techniques With First-Trimester Pregnancy Outcome.

    Heller, Howard T / Asch, Elizabeth A / Durfee, Sara M / Goldenson, Robin P / Peters, Hope E / Ginsburg, Elizabeth S / Doubilet, Peter M / Benson, Carol B

    Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

    2018  Volume 37, Issue 7, Page(s) 1725–1732

    Abstract: ... 8 weeks (3.6%; P < .001). The size of the hematoma estimated as a fraction of gestational sac size ... significantly correlated with first-trimester pregnancy loss (P < .001). There was no statistical significance ...

    Abstract Objectives: To evaluate and compare grading systems of subchorionic hematoma (SCH) on first-trimester ultrasound examinations with live embryos to assess which best correlates with early pregnancy outcome and to assess the effect of gestational age at the time of diagnosis on outcome.
    Methods: First-trimester live singleton pregnancies between 6 and 11 weeks' gestational age with SCH were identified by an institutional database search. First-trimester outcome was categorized as "live" or "demise" based on ultrasound or medical record documentation. Hematomas were categorized in 4 ways: (1) subjective (small, moderate, or large); (2) subjective size based on fraction comparison with gestational sac size; (3) subjective grading based on the estimated percentage of the gestational sac surrounded by hematoma; and (4) 3 orthogonal measurements of the hematoma.
    Results: A total of 434 sonograms met study inclusion criteria. The overall rate of first-trimester pregnancy failure was 12.0%. The rate of demise was significantly higher for hematomas diagnosed at or before 7 weeks (19.6%) than for those after 8 weeks (3.6%; P < .001). The size of the hematoma estimated as a fraction of gestational sac size significantly correlated with first-trimester pregnancy loss (P < .001). There was no statistical significance between first-trimester outcome and the other 2 subjective grading methods. Volume-based measurements provided spurious results because of the irregular shape of most hematomas.
    Conclusions: Subjective hematoma size based on the fraction of gestational sac size correlates best with first-trimester pregnancy outcome. The earlier in pregnancy an SCH is detected, the higher the rate of subsequent pregnancy failure.
    MeSH term(s) Adult ; Chorion/diagnostic imaging ; Female ; Gestational Age ; Hematoma/diagnostic imaging ; Hematoma/epidemiology ; Humans ; Pregnancy ; Pregnancy Complications/diagnostic imaging ; Pregnancy Complications/epidemiology ; Pregnancy Outcome/epidemiology ; Pregnancy Trimester, First ; Sensitivity and Specificity ; Severity of Illness Index ; Ultrasonography, Prenatal/methods
    Language English
    Publishing date 2018-01-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 604829-8
    ISSN 1550-9613 ; 0278-4297
    ISSN (online) 1550-9613
    ISSN 0278-4297
    DOI 10.1002/jum.14524
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  9. Article ; Online: Adnexal sonographic findings in ectopic pregnancy and their correlation with tubal rupture and human chorionic gonadotropin levels.

    Frates, Mary C / Doubilet, Peter M / Peters, Hope E / Benson, Carol B

    Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine

    2014  Volume 33, Issue 4, Page(s) 697–703

    Abstract: ... of the sonogram. A moderate-to-large amount of free fluid was significantly associated with tubal rupture (P < .05 ...

    Abstract Objectives: To determine whether the distribution of transvaginal sonographic findings of ectopic pregnancy has changed since the studies done 20 years ago and to explore the correlation of tubal rupture with transvaginal sonographic findings and human chorionic gonadotropin (hCG) levels.
    Methods: Patients with ectopic pregnancy who underwent transvaginal sonography before treatment were included. Sonograms and medical records were retrospectively reviewed. The presence of a tubal ring, the presence of a yolk sac, embryonic cardiac activity, the degree of vascularity on color Doppler imaging, hCG levels, and results of surgery were recorded.
    Results: Our study included 231 ectopic pregnancies. A positive sonographic adnexal finding was present in 219 cases (94.8%): adnexal mass in 218 (94.4%) and a moderate-to-large amount of free fluid in 84 (36.4%). The adnexal masses were graded as follows: 1, nonspecific mass (125 cases [54.1% of total]); 2, tubal ring without a yolk sac or embryo (57 [24.7%]); 3, yolk sac but no embryonic heartbeat (19 [8.3%]); and 4, embryo with cardiac activity (17 [7.4%]). The mean hCG level increased as the grade ascended from 1 to 4. Thirty-six patients had tubal rupture at surgery within 24 hours of the sonogram. A moderate-to-large amount of free fluid was significantly associated with tubal rupture (P < .05) but had low sensitivity, specificity, and positive predictive value for rupture. Other sonographic findings and hCG levels were not significantly related to tubal rupture.
    Conclusions: Transvaginal sonography showed an adnexal abnormality in nearly 95% of our patients with ectopic pregnancy, most commonly a nonspecific adnexal mass. Embryonic cardiac activity was seen in fewer than 10%. Neither sonographic findings nor hCG levels were useful predictors of tubal rupture.
    MeSH term(s) Adnexal Diseases/blood ; Adnexal Diseases/diagnosis ; Adult ; Chorionic Gonadotropin/blood ; Female ; Humans ; Middle Aged ; Pregnancy ; Pregnancy, Tubal/blood ; Pregnancy, Tubal/diagnosis ; Reproducibility of Results ; Rupture, Spontaneous ; Sensitivity and Specificity ; Statistics as Topic ; Ultrasonography, Prenatal/methods ; Uterine Rupture/blood ; Uterine Rupture/diagnosis ; Young Adult
    Chemical Substances Chorionic Gonadotropin
    Language English
    Publishing date 2014-04
    Publishing country England
    Document type Comparative Study ; Journal Article
    ZDB-ID 604829-8
    ISSN 1550-9613 ; 0278-4297
    ISSN (online) 1550-9613
    ISSN 0278-4297
    DOI 10.7863/ultra.33.4.697
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  10. Article ; Online: Testicular microlithiasis: prevalence and association with primary testicular neoplasm.

    Heller, Howard T / Oliff, Matthew C / Doubilet, Peter M / O'Leary, Michael P / Benson, Carol B

    Journal of clinical ultrasound : JCU

    2014  Volume 42, Issue 7, Page(s) 423–426

    Abstract: ... from 4.6% for those examined before 2001 to 9.02% for those examined since 2001 (p < 0.001 ... whereas in those with microlithiasis it was 12% (53/456) (p < 0.001). The prevalence of pure seminoma was 39% (33/84 ... in the nonmicrolithiasis group with tumor versus 64% (34/53) in the microlithiasis group with tumor (p < 0.001 ...

    Abstract Purpose: To assess the prevalence of testicular microlithiasis and its association with primary testicular neoplasm.
    Methods: Evaluated were 6,002 patients undergoing scrotal ultrasound at our institution. Data recorded included age, ultrasound date, presence of microlithiasis, presence of testicular mass on ultrasound, and pathologic diagnosis for those who had subsequent orchiectomy.
    Results: Four hundred fifty-six of 6,002 patients (7.6%) demonstrated testicular microlithiasis. The prevalence increased from 4.6% for those examined before 2001 to 9.02% for those examined since 2001 (p < 0.001). The prevalence of primary testicular neoplasm in patients without microlithiasis was 1.5% (84/5,546), whereas in those with microlithiasis it was 12% (53/456) (p < 0.001). The prevalence of pure seminoma was 39% (33/84) in the nonmicrolithiasis group with tumor versus 64% (34/53) in the microlithiasis group with tumor (p < 0.001). Germ cell tumors made up 98% of neoplasms in patients with microlithiasis, but only 85% in patients without microlithiasis (p = 0.009).
    Conclusions: Advances in ultrasound technology have led to an increased detection of testicular microlithiasis. We observed an eight-fold increased prevalence of primary testicular neoplasm in patients with microlithiasis than in those without as well as an increased prevalence of germ cell tumors, particularly pure seminoma. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42:423-426, 2014.
    MeSH term(s) Adult ; Calculi/diagnostic imaging ; Calculi/epidemiology ; Calculi/etiology ; Diagnosis, Differential ; Humans ; Male ; Prevalence ; Retrospective Studies ; Risk Factors ; Testicular Diseases/diagnostic imaging ; Testicular Diseases/epidemiology ; Testicular Diseases/etiology ; Testicular Neoplasms/complications ; Testicular Neoplasms/diagnostic imaging ; Testicular Neoplasms/epidemiology ; Ultrasonography ; United States/epidemiology
    Language English
    Publishing date 2014-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 189393-2
    ISSN 1097-0096 ; 0091-2751
    ISSN (online) 1097-0096
    ISSN 0091-2751
    DOI 10.1002/jcu.22144
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