Intrauterine Pregnancy Of Uncertain Viability Research Articles

P-404 Usability, accuracy and cost-effectiveness of “eDiagEPU”, a medical software for early pregnancies: a retrospective study

Abstract Study question Can early pregnancies be accurately and cost-effectively diagnosed and managed using a new medical computerised tool, named “eDiagEPU”? Summary answer Compared to the standard clinical approach, the retrospective implementation of “eDiagEPU” in a gynaecological emergency unit was correlated with sharper diagnoses and more cost-effective managements. What is known already Early pregnancies complications are responsible for a large percentage of consultations, mostly in emergency units. Moreover, clinical guidelines updates for the management of Intrauterine Pregnancies of Uncertain Viability (IPUV) have become increasingly complex and seem to be unknown or misunderstood by several practitioners. Specifically, a recently published prospective multinational survey revealed a limited knowledge regarding early pregnancy guidelines, with 69.0% of the participants reporting incorrect managements of IPUV and 86.6% misinterpreting the evolution of serum human chorionic gonadotropin (hCG). In an attempt to aid practitioners with the diagnosis and management of early pregnancies, a software, named “eDiagEPU”, was developed. Study design, size, duration A total of 780 consultations, recorded between November 2018 and June 2019 in the gynaecological emergency unit of a tertiary university hospital, were retrospectively encoded in eDiagEPU. Positive hCG, ultrasonographical visualisation of gestational sac or/and embryo corresponding to a gestational age of 14 weeks gestation or less were the inclusion criteria. Diagnoses and managements suggested by eDiagEPU are named “eDiagnoses”. The ones provided by a gynaecologist member of the emergency department staff are called “medDiagnoses”. Participants/materials, setting, methods Identical eDiagnosis and medDiagnosis were considered as correct (gold standard). During follow-up examinations, if they became both identical to a previous discrepant eDiagnosis or medDiagnosis, this previous eDiagnosis/medDiagnosis was considered as correct. Persistent discrepancies were reviewed by four double-blinded experts whose majority defined the correct eDiagnosis/medDiagnosis. The accuracies of eDiagnoses/medDiagnoses were compared using McNemar’s Chi square test, computing diagnostic values (Sensitivity, Specificity, and predictive values) and 95% Confidence Intervals (CI). Cost reduction was also analysed. Main results and the role of chance Only one datum (0.1%) from 780 registered medical records was missing to process using “eDiagEPU”. Out of the 779 consultations that could be fully encoded until obtaining an eDiagnosis, 675 eDiagnoses were identical to the medDiagnoses (86.6%) and 104 discrepant (13.4%). From these 104, 60 reached an agreement during follow-up controls with 59 medDiagnoses finally changing into the initial eDiagnoses (98%) while only one discrepant eDiagnosis turning later into the initial medDiagnosis (2%). Finally, 24 remained discrepant at all subsequent checks and 20 were not reevaluated. Out of these 44 discrepancies without identical diagnoses/managements during follow-up controls, the double-blinded experts majority chose 38 eDiagnoses (86%) and 5 medDiagnoses (11%) including 4 twin pregnancies whose twinness was the only discrepancy. One discrepant eDiagnosis/medDiagnosis reached no majority (2%). In total, eDiagnoses accuracy was 99.1% (675 + 59 + 38=772 eDiagnoses out of 779 final diagnoses), vs 87.4% (675 + 1 + 5=681) for medDiagnoses accuracy (p < 0.0001). Calculating all basic costs of consultations, medications, surgeries and hospitalisations induced by medDiagnoses versus eDiagnoses, “eDiagEPU” would have saved 3 623.75 € per month. Retrospectively, “eDiaEPU” was usable (99.9%), more accurate for each diagnosis except twinning report and more cost-effective than standard clinical approach. Limitations, reasons for caution The retrospective design is a limitation, as well as the quality of ultrasound interpretation. Some improvements could not derive exclusively from “eDiagEPU” but also from the encoding by a rested or more experienced physician. This software cannot replace clinical and ultrasonographical skills but can improve the diagnostic and therapeutic reasoning. Wider implications of the findings An improved “eDiagEPU” version, considering the diagnosis and management of multiple pregnancies with their specificities (potentially multiple locations, chorioamnionicity) has been developed. Prospective evaluations will be required. Further development steps are considered, including software incorporation into ultrasound devices and integration of previously published predictive/prognostic factors (serum progesterone, corpus luteum scoring...). Trial registration number NCT03993015

VP01.11: Improving early pregnancy care: a pathway for intrauterine pregnancy of uncertain viability

VP01.11: Improving early pregnancy care: a pathway for intrauterine pregnancy of uncertain viability

The Burden of Abortion Restrictions and Conservative Diagnostic Guidelines on Patient-Centered Care for Early Pregnancy Loss

Intrauterine pregnancies of uncertain viability are common, and guidelines for diagnosing early pregnancy loss must balance the risk of interrupting a viable pregnancy with the anxiety and medical complications resulting from delayed diagnosis. Two cases of likely early pregnancy loss presenting as intrauterine pregnancies of uncertain viability are described, with stark differences in care availability related to state reproductive health care regulations. Onerous abortion restrictions, medical and societal stigma, and inherent pronatalism in diagnostic criteria interfere with the exercise of clinical judgment and can damage patients' physical or mental health.

P024: Obtaining consensus on optimal management and follow-up of patients presenting to the emergency department with early pregnancy complications – a modified Delphi study

Introduction: Complications in early pregnancy are common and have many physical and emotional consequences. Locally, there is no early pregnancy loss clinic or standardized guide in the emergency department (ED) for referral and follow-up decisions, and both initial management of patients and follow up can be inconsistent. This study aimed to obtain consensus on the best approach to initial work-up, management, and follow up for patients who present to the ED with early pregnancy complications, with the goal of using this consensus to produce a standardized guide for emergency provider use. Methods: A literature review was completed to produce evidence-based recommendations which were used to initiate a modified Delphi consensus process. A survey was distributed, with three rounds completed. Participants included emergency providers, obstetrician-gynecologists, a radiologist, a sample of family medicine physicians including some involved in primary care obstetrics, and nurse practitioners. An obstetric specialist from outside the local region was also involved. Results: Consensus was reached on several key recommendations, however some areas remained without clear accepted best practice. There was consensus that physical components of early pregnancy complications are addressed well, but that we could improve on patient flow and more consistent follow up. Important investigations to be done for patients were identified. The timing of formal ultrasound, necessity and timing of obstetrician consultation, and safety of discharge was addressed for various patient scenarios including stable and unstable patients, with and without adnexal pain, with intrauterine pregnancy of uncertain viability, and with pregnancy of unknown location. Management of confirmed early pregnancy loss in the ED and family medicine clinics was addressed. Barriers to an early pregnancy loss clinic included lack of funding, space, and staffing as well as lack of resources and uncertain patient volumes. A feasible alternative to an early pregnancy loss clinic was for willing providers to keep appointment times available to facilitate confirmation of follow-up prior to discharge. Other suggested alternatives included an early pregnancy loss clinic, a nurse educator, and having a standardized guideline in the ED. Conclusion: Through a consensus approach, several recommendations were agreed upon for improving care for patients presenting to the ED with early pregnancy complications.

P03.01: Intrauterine pregnancy of uncertain viability: qualitative and quantitative analysis of knowledge of prognosis and information offered to women

P03.01: Intrauterine pregnancy of uncertain viability: qualitative and quantitative analysis of knowledge of prognosis and information offered to women

Quelle place pour l’échographie dans la pratique de l’IVG ?

Ultrasound plays a fundamental role in the management of elective abortions. Although it can improve the quality of post-abortion care, it must not be an obstacle to abortion access. We thus studied the role of ultrasound in pregnancy dating and possible alternatives and analyzed the literature to determine the role of ultrasound in post-abortion follow-up. During an ultrasound scan, the date of conception is estimated by measurement of the crown-rump length (CRL), defined by Robinson, or of the biparietal diameter (BPD), as defined by the French Center for Fetal Ultrasound (CFEF) after 11weeks of gestation (Robinson and CFEF curves) (grade B). Updated curves have been developed in the INTERGROWTH study. In the context of abortion, the literature recommends the application of a safety margin of 5days, especially when the CRL and/or BPD measurement indicates a term close to 14weeks (that is equal or below 80and 27mm, respectively) (best practice agreement). Accordingly, with the ultrasound measurement reliable to±5days when its performance meets the relevant criteria, an abortion can take place when the CRL measurement is less than 90mm or the BPD less than 30mm (INTERGROWTH curves) (best practice agreement). While a dating ultrasound should be encouraged, its absence is not an obstacle to scheduling an abortion for women who report that they know the date of their last menstrual period and/or of the at-risk sexual relations and for whom a clinical examination by a healthcare professional is possible (best practice agreement). In cases of intrauterine pregnancy of uncertain viability or of a pregnancy of unknown location, without any particular symptoms, the patient must be able to have a transvaginal ultrasound to increase the precision of the diagnosis (grade B). Various reviews of the literature on post-abortion follow-up indicate that the routine use of ultrasound during instrumental abortions should be avoided (best practice agreement). If it becomes clear immediately after the procedure that the endometrial thickness exceeds 8mm, immediate reaspiration is necessary. Ultrasound examination of the endometrium several days after an instrumental elective abortion does not appear to be relevant (grade B). An analysis of the literature similarly shows that routine ultrasound scans after medical abortions should be avoided. If a transvaginal ultrasound is performed after a medical abortion, it should take place at least two weeks afterwards (best practice agreement). The only aim of an ultrasound examination during follow-up should be to determine whether a gestational sac is present (best practice agreement). Finally, if an ultrasound is performed at any point during pre- or post-abortion care, a report should be drafted, specifying any potential gynecologic abnormalities found, but its absence must not delay the scheduling of the abortion (best practice agreement).

Defining safe criteria to diagnose miscarriage: prospective observational multicentre study

Objectives To validate recent guidance changes by establishing the performance of cut-off values for embryo crown-rump length and mean gestational sac diameter to diagnose miscarriage with high levels of certainty....

External validation of models and simple scoring systems to predict miscarriage in intrauterine pregnancies of uncertain viability

Does a logistic regression model and scoring system to predict viability of an intrauterine pregnancy of uncertain viability (PUV) perform as well in an independent patient group as the original patient group? The model and scoring system showed good performance on external validation confirming their value for the prediction of miscarriage/viability in PUV patients up to 11-14 weeks of gestation. Several individual ultrasound and demographic factors have been described as predictors for miscarriage. A logistic regression model and simple scoring system using basic clinical and ultrasound features, such as maternal age, bleeding score, mean gestational sac diameter (MSD) and presence or absence of yolk sac, have been developed to allow patient-specific prediction of viability of PUV beyond the first trimester. Prospective observational external validation cohort study in two inner city early pregnancy assessment units over a period of 18 months. All consecutive women with a PUV were recruited. Ultrasound (mean sac diameter and presence of yolk sac) and demographic variables (maternal age, bleeding score and gestational age) were noted. The outcome measure was first trimester (11-14 week) viability. Women with unknown first trimester outcome were excluded. Receiver operating characteristic (ROC) curves and calibration plots were constructed. Test performance was compared with the original development data set. A new model and scoring system, which did not include gestational age, was built and evaluated. Of the 575 women who were recruited, first trimester outcome was known for 89.2% (n = 513). The model could only be validated in 400 patients, due to missing values in model variables and outcome. The model predicted viability with an area under the ROC curve (AUC) of 0.845 [95% confidence interval (CI), 0.806-0.884] compared with 0.774 (95% CI, 0.701-0.848) in the original study. The AUC for the scoring system was 0.832 (95% CI, 0.792-0.872) compared with 0.771 (95% CI, 0.698-0.844) from the original study data set. The new model and the scoring system, excluding gestational age, could be evaluated on 503 patients and resulted in an AUC of 0.801 (95% CI, 0.765-0.841) for the model and 0.773 (95% CI, 0.733-0.812) for the scoring system. Approximately 22% of patients could not be validated due to missing variables and for 11% of patients the first trimester outcome was unknown. Both the model and the scoring system showed excellent performance on external validation confirming their generalizability and utility in prediction of viability beyond the first trimester in clinical practice. An advantage of the mathematical models original Mo and new Mn and scoring systems original SSo and new SSn is that they can provide women with an individualized probability of the viability of their pregnancy using only demographic information, symptoms and TVS findings. Furthermore, the risk of miscarriage can be given immediately following examination. T.B. is supported by the Imperial Healthcare NHS Trust NIHR Biomedical Research Centre. This research is supported by Research Council KUL GOA MaNet, iMinds 2012, Belgian Federal Science Policy Office IUAP P719. VVB is a postdoctoral fellow of the Research Foundation - Flanders (FWO). There are no conflicts of interest.

OP05.02: Improved performance of a model and simple scoring system to predict outcome of intrauterine pregnancy of uncertain viability: an external validation study

OP05.02: Improved performance of a model and simple scoring system to predict outcome of intrauterine pregnancy of uncertain viability: an external validation study

Limitations of Current Definitions of Miscarriage Using Mean Gestational Sac Diameter and Crown-Rump Length Measurements

Objectives There is significant variation in cut-off values for mean gestational sac diameter (MSD) and embryo crown–rump length (CRL) used to define miscarriage, values suggested in the literature ranging from 13 to 25 mm for MSD and from 3 to 8 mm for CRL. We aimed to define the false-positive rate (FPR) for the diagnosis of miscarriage associated with different CRL and MSD measurements with or without a yolk sac in a large study population of patients attending early pregnancy clinics. We also aimed to define cut-off values for CRL and MSD that, on the basis of a single measurement, can definitively diagnose a miscarriage and so exclude possible inadvertent termination of pregnancy. Methods This was an observational cross-sectional study. Data were collected prospectively according to a predefined protocol. Intrauterine pregnancy of uncertain viability (IPUV) was defined as an empty gestational sac or sac with a yolk sac but no embryo seen with MSD < 20 or < 30 mm or an embryo with an absent heartbeat and CRL < 6 mm or < 8 mm. We recruited to the study 1060 consecutive women with IPUV. The endpoint was presence or absence of a viable pregnancy at the time of first-trimester screening ultrasonography between 11 and 14 weeks. The sensitivity, specificity, positive and negative predictive values were calculated for potential cut-off values to define miscarriage from MSD 8 to 30 mm with or without a yolk sac and from CRL 3 to 8 mm. Results Of the 1060 women with a diagnosis of IPUV, 473 remained viable and 587 were non-viable by the time of the 11–14-week scan. In the absence of both embryo and yolk sac, the FPR for miscarriage was 4.4% when an MSD cut-off of 16 mm was used and 0.5% for a cut-off of 20 mm. There were no false-positive test results for miscarriage when a cut-off of MSD ≥ 21 mm was used. If a yolk sac was present but an embryo was not, the FPR for miscarriage was 2.6% for an MSD cut-off of 16 mm and 0.4% for a cut-off of 20 mm, with no false-positive results when a cut-off of MSD ≥ 21 mm was used. When an embryo was visible with an absent heartbeat, using a CRL cut-off of 4 mm the FPR for miscarriage was 8.3%, and for a CRL cut-off of 5 mm it was also 8.3%. There were no false-positive results using a CRL cut-off of ≥ 5.3 mm. Conclusions These data show that some current definitions used to diagnose miscarriage are potentially unsafe. Current national guidelines should be reviewed to avoid inadvertent termination of wanted pregnancies. An MSD cut-off of > 25 mm and a CRL cut-off of > 7 mm could be introduced to minimize the risk of a false-positive diagnosis of miscarriage. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Gestational sac and embryonic growth are not useful as criteria to define miscarriage: a multicenter observational study

We studied changes in mean gestational sac diameter (MSD) and embryonic crown-rump length (CRL) in intrauterine pregnancies of uncertain viability (IPUVs). We aimed to establish cut-off values for MSD and CRL growth that could be definitively associated with either viability or miscarriage, and to establish the relationship between growth in MSD and appearance of embryonic structures in the gestational sac. One thousand and sixty consecutive IPUVs were recruited prospectively from four London University hospitals: 462 with no yolk sac or embryo, 419 with a yolk sac but no embryo, and 179 with an embryo but no heartbeat visible. IPUV was defined as an empty gestational sac with or without a yolk sac but no embryo seen with MSD < 20 or < 30 mm (depending on center) or an embryo with no heartbeat and CRL < 6 mm or < 8 mm (depending on center). Scans were repeated 7-14 days later. The endpoint was viability at first-trimester screening ultrasonography between 11 and 14 weeks. Change in MSD and CRL between the first and second scans of each pregnancy was compared with respect to viability and appearance of embryonic structures using the two-sample t-test. The study included 359 pregnancies in which a gestational sac with or without embryo was identified at the follow-up scan 7-14 days later. Of these, 192 were viable and 167 non-viable at the 11-14-week scan. MSD growth was significantly higher in viable than non-viable pregnancies (mean 1.003 vs. 0.503 mm/day; P < 0.001, 95% CI of difference 0.403-0.596). A difference in CRL growth was found between the two groups (mean 0.673 vs. 0.148 mm/day; P < 0.001, 95% CI of difference 0.345-0.703). MSD growth of 0.6 mm/day was associated with a specificity for diagnosing miscarriage of 90.1%, a sensitivity of 61.7% and 19 false-positive test results. A cut-off of CRL growth rate of 0.2 mm/day gave a sensitivity of 76.3% and there were no false-positive test results for miscarriage. On repeat scan the failure of either a yolk sac or embryo to be visualized was always associated with miscarriage. There is an overlap in MSD growth rates between viable and non-viable IPUV. No cut-off exists for MSD growth below which a viable pregnancy could be safely excluded. A cut-off value for CRL growth of 0.2 mm/day was always associated with miscarriage. These data suggest that criteria to diagnose miscarriage based on growth in MSD and CRL are potentially unsafe. However, finding an empty gestational sac on two scans more than 7 days apart is highly likely to indicate miscarriage, irrespective of growth.

Limitations of current definitions of miscarriage using mean gestational sac diameter and crown–rump length measurements: a multicenter observational study

There is significant variation in cut-off values for mean gestational sac diameter (MSD) and embryo crown-rump length (CRL) used to define miscarriage, values suggested in the literature ranging from 13 to 25 mm for MSD and from 3 to 8 mm for CRL. We aimed to define the false-positive rate (FPR) for the diagnosis of miscarriage associated with different CRL and MSD measurements with or without a yolk sac in a large study population of patients attending early pregnancy clinics. We also aimed to define cut-off values for CRL and MSD that, on the basis of a single measurement, can definitively diagnose a miscarriage and so exclude possible inadvertent termination of pregnancy. This was an observational cross-sectional study. Data were collected prospectively according to a predefined protocol. Intrauterine pregnancy of uncertain viability (IPUV) was defined as an empty gestational sac or sac with a yolk sac but no embryo seen with MSD < 20 or < 30 mm or an embryo with an absent heartbeat and CRL < 6 mm or < 8 mm. We recruited to the study 1060 consecutive women with IPUV. The endpoint was presence or absence of a viable pregnancy at the time of first-trimester screening ultrasonography between 11 and 14 weeks. The sensitivity, specificity, positive and negative predictive values were calculated for potential cut-off values to define miscarriage from MSD 8 to 30 mm with or without a yolk sac and from CRL 3 to 8 mm. Of the 1060 women with a diagnosis of IPUV, 473 remained viable and 587 were non-viable by the time of the 11-14-week scan. In the absence of both embryo and yolk sac, the FPR for miscarriage was 4.4% when an MSD cut-off of 16 mm was used and 0.5% for a cut-off of 20 mm. There were no false-positive test results for miscarriage when a cut-off of MSD ≥ 21 mm was used. If a yolk sac was present but an embryo was not, the FPR for miscarriage was 2.6% for an MSD cut-off of 16 mm and 0.4% for a cut-off of 20 mm, with no false-positive results when a cut-off of MSD ≥ 21 mm was used. When an embryo was visible with an absent heartbeat, using a CRL cut-off of 4 mm the FPR for miscarriage was 8.3%, and for a CRL cut-off of 5 mm it was also 8.3%. There were no false-positive results using a CRL cut-off of ≥ 5.3 mm. These data show that some current definitions used to diagnose miscarriage are potentially unsafe. Current national guidelines should be reviewed to avoid inadvertent termination of wanted pregnancies. An MSD cut-off of > 25 mm and a CRL cut-off of > 7 mm could be introduced to minimize the risk of a false-positive diagnosis of miscarriage.

P27.03: Outcome of the 1st trimester of intrauterine pregnancies of uncertain viability (IPUVIs)

To determine the first trimester outcome in women classified with an IPUVI at the primary scan. Prospective observational study. All pregnant women presenting to the Early Pregnancy Unit, between Nov 2006 and Dec 2010, underwent a transvaginal scan (TVS). Data was collected from all women classified with an IPUVI at 1st TVS. An IPUVI was defined if there was an empty gestational sac of < 20 mm diameter; a gestational sac with a yolk sac, but no CRL; or a gestational sac, a yolk sac, and a CRL of < 6 mm with no detectable fetal heart rate (FHR). The women were followed up until the outcome was established: viable or non-viable pregnancy at the end of the 1st trimester. 346 women were classified with an IPUVI. 276/346 (79.8%) women had no CRL seen at the first scan, 67/346 (17.9%) had a CRL of < 6 mm. For 297/346 (85.8%) IPUVIs the 1st trimester outcome was known. 154/297 (51.9%) were viable and 143/297 (48.1%) had a miscarriage. Of those IPUVIs which had no CRL on the first scan, 55.9% had a viable pregnancy and 44.1% had a miscarriage. The IPUVIs which had a CRL of < 6 mm with no FHR at the first TVS, 36.1% were viable and 63.9% were non viable at the end of the first trimester. In our study population the rate of miscarriage in the IPUVI group was high, especially in the subgroup that had a small CRL with no FHR demonstrated at the first scan. We are currently developing a model to predict the outcome of the first trimester for IPUVIs.

P27.07: Intrauterine pregnancy of uncertain viability: what influences outcome of the first trimester?

The aim was to determine variables that are associated with a higher risk of miscarriage in the 1st trimester in women with an intrauterine pregnancy of uncertain viability (IPUVI). Prospective observational study. Women in the 1st trimester of pregnancy presenting to the Early Pregnancy Unit (EPU), between Nov 2006 and Dec 2010, underwent a transvaginal scan (TVS). Data was collected from women with an IPUVI at the first ultrasound (US). More than 40 historical, clinical and US end points were recorded for analysis. US measurements included gestational sac (GS) and yolk sac (YS) in three planes, crown–rump length (CRL) and fetal heart rate (FHR). Women were followed up until the outcome was established: viable or non-viable IUP at the end of the 1st trimester. Univariate analysis to study the effect of the variables on the first trimester outcome was performed using ANOVA F-test and Fisher's exact test. 346 pregnancies were included. 45.7% (158/346) were viable at the end of the 1st trimester, 41.6% (144/346) were non-viable and 10.4% (36/346) did not have 1st trimester outcomes available. The continuous variables that were significantly associated with a higher rate of miscarriage were: higher maternal age (mean maternal age for viable pregnancies 26.9 yrs vs. mean maternal age for miscarriages 30.7 yrs, P value = 3.33E-05), higher gestational age (GA) in days by LMP (mean GA for viable pregnancies 41.9 days vs. mean GA for miscarriages 52.7 days, P value = 1.78E-12), and higher CRL (mean CRL for viable pregnancies 0.22 mm vs. mean CRL for miscarriages 0.95 mm, P = 1.91E-05). The categorical variables that were associated with a higher rate of miscarriage were: previous miscarriage, history of vaginal bleeding with clots and the presence of a CRL at first scan. The rate of miscarriage in our IPUVI population was high. We have identified 7 variables, which can be established at the first visit to the EPU that were associated with an increased risk of miscarriage in that group.

OP02.06: New model to predict viability at the end of the first trimester for women with an intrauterine pregnancy of uncertain viability (IPUVI)

OP02.06: New model to predict viability at the end of the first trimester for women with an intrauterine pregnancy of uncertain viability (IPUVI)

P27.04: Do intrauterine pregnancies of uncertain viability becoming viable after the 1st ultrasound behave differently to initially viable intrauterine pregnancies?

P27.04: Do intrauterine pregnancies of uncertain viability becoming viable after the 1^st ultrasound behave differently to initially viable intrauterine pregnancies?

A model and scoring system to predict outcome of intrauterine pregnancies of uncertain viability

To define the incidence and outcome of intrauterine pregnancy of uncertain viability (PUV) and to develop and assess the performance of a model and a scoring system to predict ongoing viability. Of 1881 consecutive women undergoing transvaginal ultrasonography, a cohort of 493 women with an empty gestational sac < 20 mm in mean diameter, gestational sac < 25 mm in mean diameter and containing yolk sac only or an embryonic pole < 6 mm in maximum length and without visible heart activity were followed until the end of the first trimester. Women with multiple pregnancies or who underwent termination of pregnancy were excluded. Outcome measures were pregnancy viability at initial 7-14-day follow-up and first-trimester viability at 11-14 weeks. The data were split randomly into two sets (two-thirds and one-third, respectively) in order to first develop and then test a mathematical model and a 'simple' model in the prediction of viability at each outcome point, based on maternal demographics, ultrasound features and symptoms. The performance of each system was assessed by receiver-operating characteristics (ROC) curve analysis and calibration plots on a test dataset. The incidence of PUV in this population was 29.2% (549/1881). Of the 493 pregnancies with initial (7-14 days) follow-up available, 307 (62.3%) were viable at this time and of the 444 pregnancies with follow-up at the end of the first trimester, 225 (50.7%) were still viable. Initial (7-14-day) viability was predicted by the model with an area under the ROC curve (AUC) of 0.837 (95% CI, 0.791-0.884) in the training dataset and 0.821 (95% CI, 0.756-0.885) in the test dataset. First-trimester (11-14-week) viability was predicted by the model with an AUC of 0.788 (95% CI, 0.734-0.842) in the training dataset and 0.774 (95% CI, 0.701-0.848) in the test dataset. The scoring system performed slightly worse than did the model, but had the advantage of being easily applicable. When early pregnancy viability cannot be established immediately with ultrasound, use of either a logistic regression model or a scoring system allows an individualized prediction of first-trimester outcome.

OC05.08: Outcome of the 1st trimester of intrauterine pregnancies of uncertain viability (IPUVIs)

Objectives: To determine the first trimester outcome in women classified with an IPUVI at the primary scan. Methods: Prospective observational study. All pregnant women presenting to the EPU, between Nov 2006 and Jan 2010, underwent a transvaginal scan (TVS). Data were collected from all women classified with an IPUVI at 1st TVS. An IPUVI was defined if there was an empty gestational sac of <20 mm diameter; a gestational sac with a yolk sac, but no CRL; or a gestational sac, a yolk sac, and a CRL of <6 mm with no detectable fetal heart rate (FHR). The women were followed up until the outcome was established: viable or non-viable pregnancy at the end of the 1st trimester. Results: 2048 consecutive pregnant women underwent TVS. 268/2048 (13.1%) were classified with an IPUVI. 220 women (82.1%) had no CRL seen at the first scan, 48 (17.9%) had a CRL of <6 mm. For 237 IPUVIs the 1st trimester outcome was known. 124 (52.3%) were viable and 113 (47.7%) had a miscarriage. Of those IPUVIs which had no CRL on the first scan 57% had a viable pregnancy and 43% had a miscarriage. Of the IPUVIs which had a CRL of <6 mm with no FHR at the first TVS 32.6% were viable and 67.4% were non viable at the end of the first trimester. Conclusions: In our study population the rate of miscarriage in the IPUVI group was high, especially in the subgroup that had a small CRL with no FHR demonstrated at the first scan. We are currently developing a model to predict the outcome of the first trimester for IPUVIs.

P02.03: Longitudinal growth of MSD and CRL in intrauterine pregnancies of uncertain viability (IPUV) and its relationship to gestation sac shape

P02.03: Longitudinal growth of MSD and CRL in intrauterine pregnancies of uncertain viability (IPUV) and its relationship to gestation sac shape

OC05.07: Gestation sac shape, sub‐chorionic haematoma and vaginal bleeding as predictors of viability in intrauterine pregnancies of uncertain viability (IPUV)

OC05.07: Gestation sac shape, sub‐chorionic haematoma and vaginal bleeding as predictors of viability in intrauterine pregnancies of uncertain viability (IPUV)