There is a multi-society consensus on first-trimester imaging guidelines that identify reliable sonographic signs indicative of non-viable pregnancies, yet inconsistency remains in the terminology used in imaging reports and patient communications. Commonly used terms are often outdated, confusing, applied inconsistently, or understood differently by radiologists, clinicians, and patients. In response, for the first time, a multi-medical society panel has created and endorsed a uniform lexicon for describing ultrasound observations during the first trimester of pregnancy. This lexicon is based on scientific evidence, societal guidelines, and expert consensus, and clarifies terms commonly found in first-trimester ultrasound reports, such as ‘ectopic pregnancy,’ ‘heartbeat,’ ‘living,’ and ‘viable.’

The panel was convened by the Society of Radiologists in Ultrasound (SRU, Tampa, FL, USA) along with other societies also participating in the development of the lexicon which was published in the journal Radiology and simultaneously in the American Journal of Obstetrics & Gynecology. The expert panel worked for 18 months to reach a unanimous or near-unanimous consensus on the preferred terms, synonyms, and terms to avoid in the first-trimester ultrasound report. Recognizing the gradual and incomplete nature of cardiac development early in pregnancy, the panel advised using ‘cardiac activity’ rather than ‘heart motion’ or ‘heartbeat.’

Moreover, the panel advised against using terms like ‘live,’ ‘living,’ and ‘viable,’ which might generate unrealistic expectations for patients at risk of pregnancy loss or facing an ectopic pregnancy. While ‘miscarriage’ and ‘spontaneous abortion’ are still included, the term ‘pregnancy failure’ has been updated to ‘early pregnancy loss.’ An intrauterine pregnancy is defined as one implanted in a normal location, whereas an embryo located abnormally inside (e.g., within a cesarean scar) or outside the uterus is considered an ectopic pregnancy. The endorsement of this new first-trimester ultrasound lexicon by all participating societies suggests it will gain broad acceptance.

“We recognize that specific language in the medical record could be used by third parties to negatively affect the physician-patient relationship,” said Lori M. Strachowski, M.D., senior author and UCSF clinical professor of radiology and biomedical imaging and obstetrics, gynecology and reproductive sciences, who was one of the members to lead the team. “Our goal was to recommend clear, specific, scientifically based and medically appropriate terminology that communicates clearly across disciplines, minimizes bias and harm, and respects patient preferences.” 

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