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© 2010 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 29:237-241 • 0278-4297

The Yolk Stalk Sign

Evidence of Death in Small Embryos Without Heartbeats

Marcus R. Filly, BA, Peter W. Callen, MD, N. Tugce Yegul, MD and Roy A. Filly, MD

Ohio State University College of Medicine, Columbus, Ohio USA (M.R.F.); and Department of Radiology and Biomedical Imaging, University of California, San Francisco, California USA (P.W.C., N.T.Y., R.A.F.).

Address correspondence to Roy A. Filly, MD, Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, San Francisco, CA 94143-0628 USA. E-mail: roy.filly{at}radiology.ucsf.edu

Objective. The purpose of this study was to assess the positive predictive value for confirming early embryonic death in the clinical sonographic scenario wherein an embryo is identified without a visible heartbeat; the embryonic crown-rump length (CRL) is 5 mm or less; and the embryo is not immediately adjacent to the yolk sac. Methods. A retrospective study of 882 first-trimester sonograms was performed among women who had an intrauterine pregnancy of uncertain viability based on 1 or more sonographic findings (eg, no visible heartbeat in an embryo with a CRL of ≤5 mm). Eight hundred six cases met the inclusion criteria. Results. Among the cohort of 806 cases, 520 (64.5%) had an identifiable embryo. One hundred fifty-nine of these embryos had no demonstrable heartbeat and a CRL of 5 mm or less. The CRLs of these embryos ranged from 1.7 to 5.4 mm. This cohort’s sonograms were reviewed to determine whether there was a separation between the embryo and yolk sac. Twenty-one cases were discovered. Recall that as a retrospective study, no specific effort was made to show this finding. Thus, a computation of the sensitivity of this finding would result in an underestimate of indeterminate magnitude. All of these cases were subsequently proven to be failed pregnancies. Conclusions. The positive predictive value of the "yolk stalk sign" in determining early pregnancy failure for an embryo with a CRL of 5 mm or less and no visible heartbeat was 100% in this cohort.

Key Words: early pregnancy failure • embryonic death • sonography • yolk stalk

Abbreviations: CRL, crown-rump length

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