Experts: Don’t use “heartbeat” to describe ultrasound findings in early pregnancy

A multisociety panel of obstetricians, gynecologists, radiologists and emergency physicians determined that some terms commonly used to describe findings seen on ultrasound during the first trimester of pregnancy are outdated and should be replaced with more descriptive language.

Terms like “heartbeat” or “heart motion” should be replaced with “cardiac activity” because heart development is gradual and the heart chambers are not fully formed by the end of the first trimester, according to Dr. Lori Strachowski of the University of California, San Francisco, and colleagues on a panel convened by the Society of Radiologists in Ultrasound.

Instead of saying “pregnancy failure” — a term that didn’t sit well with patients, Strachowski said in a statement — health care professionals should refer to it as “early pregnancy loss,” with relevant modifiers such as “concerned about, diagnosis of, in progress, incomplete and completed.”

The consensus recommendations were jointly published in Radiology and the American Journal of Obstetrics and Gynecology.

“Our goal was to establish clear, logical, and respectful terminology to be used in the diagnosis and treatment of first-trimester pregnancy,” the authors wrote, noting that panelists either unanimously agreed or reached 80 percent agreement on preferred terms.

Some terms should be abandoned altogether, such as “fetal pole,” “pseudosac” and “angular pregnancy.” The panel also recommended against using words like “viable,” “alive” or “living,” in part because those terms “may be appropriated by people outside the medical field to support political rhetoric and proscriptive legislation,” the authors wrote.

In addition, the definition of ectopic pregnancy was expanded to cover any pregnancy implanted in an abnormal location, and the report prefixes that location (tubal, interstitial, cervical, etc.) to the term “ectopic pregnancy,” along with other descriptive terminology. This allows for the inclusion of both extrauterine and intrauterine sites (including cesarean scar implantations) to emphasize the high risk of maternal morbidity and mortality in ectopic pregnancies.

Shuchi Rodgers, MD, of the Sidney Kimmel School of Medicine at Thomas Jefferson University in Philadelphia and chair of the panel, noted in a news release that many commonly used terms “are outdated or confusing, used inconsistently, or may be interpreted differently by radiologists, physicians and patients.”

The panel prioritized reaching consensus on terminology that was “clear, specific, scientifically based and medically appropriate” and acceptable to relevant medical professionals and patients in order to reduce potential bias and harm, Strachowski said.

In conclusion, the authors noted that “just as advances in transvaginal ultrasound have helped revolutionize the care of obstetric patients, the terminology used for optimal interpretation and communication must continue to evolve in a consistent and well-defined manner.”

In an accompanying editorial, Dr. Leslie Scoutt of Yale School of Medicine in New Haven, Connecticut, and Dr. Mary Norton of the University of California, San Francisco, noted that more and more patients are seeing imaging reports, not just health care professionals.

“It is therefore imperative that language used in reports be respectful, understanding and compassionate, without raising false expectations and that it also reflect the patient’s preferences,” Scoutt and Norton wrote. They also noted that “imprecise and inaccurate language may also be misinterpreted by judicial or legislative systems and result in the denial of appropriate, potentially life-saving intervention.”

Dr. Christopher Zahn, chief of clinical practice and health equity and quality at the American College of Obstetricians and Gynecologists (ACOG), said: MedPage today “Confusion regarding inconsistently used terminology can lead to harmful delays in care, and as obstetricians and gynecologists, we want to ensure that our patients have clear information so they can better access the care they need.” She also noted that “this has become even more important since the Dobbs decision, when abortion bans mean that information in a patient’s record can determine whether or not they can access the reproductive health care they need.”

The multidisciplinary panel included members of the Society of Abdominal Radiology, the American College of Radiology, ACOG, the American Institute of Ultrasound in Medicine, the Society for Maternal-Fetal Medicine, the American Society for Reproductive Medicine, the Society of Planned Parenthood, and the American College of Emergency Physicians.

Panel members were nominated by their society, invited by the panel chair, and recruited from across the United States to ensure a diversity of perspectives. The panel used a modified Delphi process and reviewed existing literature and guidelines in PubMed and Ovid.