Mean Gestational Sac Diameter Research Articles

O-203 Comparing viable and non-viable IVF early pregnancy measurements: does knowledge of gestational age using date of ET potentially change miscarriage diagnosis guidelines in IVF patients

Abstract Study question In IVF pregnancies with known embryo transfer (ET) dates, can gestational age as well as ultrasound measurements be used to diagnose miscarriage? Summary answer Early pregnancy measurements vary at fixed gestational ages based on ET. However, there is a specific time cut-off where an empty gestational sac indicates miscarriage. What is known already Current guidelines state that when ultrasound findings show a pregnancy of unknown viability, a repeat scan must be performed either 7 or 14 days later (depending on the presence of an embryo or gestation sac size) to confirm viability, irrespective of the LMP based gestational age. This definition only considers ultrasound measurements, and even when the pregnancy dates thought to be certain and based on day of ET date, there are no exceptions to this guidance. Study design, size, duration This was a retrospective cohort study within a London tertiary unit, Wolfson Clinic, Hammersmith Hospital, Imperial College Healthcare NHS Trust over a 36-month time period. We collated data from both fresh and frozen cycle IVF pregnancies over four years: Jan 1st 2019 to December 31st 2021. Participants/materials, setting, methods In this unit, patients undergoing fresh or frozen IVF cycles, have an embryo transfer at Day3-6 of development. We included any patient with a confirmed intrauterine pregnancy at first scan (5-8 weeks gestation) for analysis of pregnancy outcomes. The data collected included date of embryo transfer (ET), embryo age at transfer, and early pregnancy measurements using ultrasound. The endpoint was viability at the 11-14 week dating scan. Main results and the role of chance 1161 IVF embryo transfers were included in the study, 677 (58.3%) frozen and 484 (41.7%) fresh cycles. 892 (76.8%) remained viable at 11-14 weeks and 269 (23.2%) were non-viable. Pregnancies resulting in viable pregnancies had a range of CRL (≤16mm) and empty mean gestation sac diameter (MSD) (≤11mm) measurements at each expected age by ET date (≤8 weeks gestation). At 49 days CRL varied from 1mm to 17mm, and at 42 days empty MSD measurements varied from 7 to 18mm. This shows that a range in embryo and gestation sac sizes will be seen in subsequently shown to be viable pregnancies despite the apparent exact gestation being known based on ET. This may relate to both differing embryo growth rates and timing of implantation. A Kolmogorov-Smirnov test was applied to compare the viable and miscarriage cohort CRL measurements in relation to expected age by ET. The result: 0.610, p-value=1.33 x10-15, demonstrated a significant difference in embryo size between viable and non-viable pregnancies with known ET dates. All pregnancies where the scan showed an empty gestational sac (n = 157) at 47 days gestation by ET date, had a 100% positive predictive value with a 100% specificity (CI:90.1-100.0) for miscarriage. Limitations, reasons for caution The sample was powered to 0.9, significance level 0.05. Analysis demonstrated 100% positive predictive value with 100% specificity (CI:90.1-100.0), to confirm miscarriage with an empty gestation sac ≥47days age by ET date. A larger cohort size from different centres is needed to reduce the confidence interval and confirm the findings. Wider implications of the findings There is significant variation in CRL and MSD size between viable pregnancies of the same gestational age by ET. However, we found >47 days gestation an empty gestation sac resulted in miscarriage. If confirmed in larger studies this may permit women to be given an earlier definitive diagnosis of miscarriage. Trial registration number Audit registration GRM_104 Imperial Healthcare NHS Trust

Clinical value of ultrasonic indicators in predicting the outcome of caesarean scar pregnancy after pregnancy termination

BackgroundTo investigate the predictive value of ultrasound indicators in early pregnancy for the outcome of caesarean scar pregnancy (CSP) after pregnancy termination.MethodsThis study retrospectively analysed the ultrasound images of 98 CSP patients who underwent transabdominal ultrasound-guided hysteroscopic curettage during early pregnancy at Changsha Hospital for Maternal and Child Health Care between January 2017 and October 2021. Patients were equally divided into a case group and a control group. The case group included 49 CSP patients with postoperative complications, such as intraoperative blood loss ≥ 200 ml or retained products of conception (RPOC). The remaining 49 CSP patients, with similar age and gestational age and with good postoperative outcomes, such as intraoperative blood loss ≤ 50 ml and no RPOC, were included in the control group. CSP was classified into three types according to the location of the gestational sac (GS) relative to the uterine cavity line (UCL) and serosal contour. Differences in ultrasound indicators between the case and control group were compared.ResultsThere were significant differences between the case and control groups in the mean gestational sac diameter (MGSD), residual myometrium thickness (RMT) between the GS and the bladder, blood flow around the GS at the site of the previous caesarean incision, and types of CSP (P < 0.05). The rs of each ultrasound indicator were as follows: 0.258, -0.485, 0.369, 0.350. The optimal threshold for predicting good postoperative outcomes, such as intraoperative blood loss ≤ 50 ml and no RPOC, by receiver operating characteristic (ROC) curve analysis of the RMT was 2.3 mm.ConclusionOur findings show that the RMT, blood flow around the GS at the site of the previous caesarean incision, and types of CSP have a low correlation with postoperative complications, such as intraoperative blood loss ≥ 200 ml or RPOC, of early pregnancy termination in patients with CSP. To some extent, this study may be helpful for clinical prognostic prediction of patients with CSP and formulation of treatment strategies. Given the low correlation between these three indicators and postoperative complications, further studies are needed to identify indicators that can better reflect the postoperative outcomes of CSP patients.

Using simple clinical and ultrasound variables to develop a model to predict first trimester pregnancy viability

IntroductionEarly prediction of pregnancies destined to miscarry will allow couples to prepare for this common but often unexpected eventuality, and clinicians to allocate finite resources. We aimed to develop a prediction model combining clinical, demographic, and sonographic data as a clinical tool to aid counselling about first trimester pregnancy outcome. Material and methodsThis is a prospective, observational cohort study conducted at Queen Charlotte’s and Chelsea Hospital, UK from March 2014 to May 2019. Women with confirmed intrauterine pregnancies between 5 weeks and their dating scan (11–14 weeks) were recruited. Participants attended serial ultrasound scans in the first trimester and at each visit recorded symptoms of vaginal bleeding, pelvic pain, nausea and vomiting using validated scoring tools. Pregnancies were followed up until the dating scan (11–14 weeks). Univariate and multivariate analyses were performed to predict first trimester viability. A model was developed with multivariable logistic regression, variables limited by feature selection, and bootstrapping with multiple imputation was used for internal validation. Results1403 women were recruited and after exclusions, data were available for 1105. 160 women (14.5 %) experienced first trimester miscarriage and 945 women (85.5 %) had viable pregnancies at 11–14 weeks’ gestation. The average gestational age at the initial visit (calculated from the menstrual dates) was 7 + 1 weeks (+/-12.2 days). A multivariable logistic regression model was developed to predict first trimester viability and included the variables: mean gestational sac diameter, presence of fetal heart pulsations, difference in gestational age from last menstrual period and from mean sac diameter on ultrasonography, current folic acid usage and maternal age. The model demonstrated good performance (optimism-corrected area under curve (AUC) 0.84, 95 % CI 0.81–0.87; optimism-corrected calibration slope 0.969). ConclusionWe have developed and internally validated a model to predict first trimester viability with good accuracy prior to the 11–14 week dating scan, which now needs to be externally validated prior to clinical use.

A Novel Approach to Predicting Early Pregnancy Outcomes Dynamically in a Prospective Cohort Using Repeated Ultrasound and Serum Biomarkers

This study aimed to develop a dynamic model for predicting outcome during the first trimester of pregnancy using baseline demographic data and serially collected blood samples and transvaginal sonographies. A prospective cohort of 203 unselected women with an assumed healthy pregnancy of < 8 weeks’ gestation was followed fortnightly from 4–14 weeks’ gestation until either miscarriage or confirmed first trimester viability. The main outcome was development of a model to predict outcome from gestational age-dependent hazard ratios using both baseline and updated serial data from each visit. Secondary outcomes were descriptions of risk factors for miscarriage. The results showed that 18% of the women experienced miscarriages. A fetal heart rate detected before 8 weeks’ gestation indicated a 90% (95% CI 85–95%) chance of subsequent delivery. Maternal age (≥ 35 years), insufficient crown-rump-length (CRL) and mean gestational sac diameter (MSD) development, and presence of bleeding increased the risk of miscarriage. Serum biomarkers, including hCG, progesterone, and estradiol, were found to impact the risk of miscarriage with estradiol as the most important. The best model to predict miscarriage was a combination of maternal age, vaginal bleeding, CRL, and hCG. The second-best model was the sonography-absent model of maternal age, bleeding, hCG, and estradiol. This study suggests that combining maternal age, and evolving data from hCG, estradiol, CRL, and bleeding could be used to predict fetal outcome during the first trimester of pregnancy.Trial registration ClinicalTrials.gov identifier: NCT02761772.

Biomarkers at 6 weeks' gestation in the prediction of early miscarriage in pregnancy following assisted reproductive technology.

Miscarriage is a major concern in early pregnancy among women having conceived with assisted reproductive treatments. This study aimed to examine potential miscarriage-related biophysical and biochemical markers at 6 weeks' gestation among women with confirmed clinical pregnancy following in vitro fertilization (IVF)/embryo transfer (ET) and evaluate the performance of a model combining maternal factors, biophysical and biochemical markers at 6 weeks' gestation in the prediction of first trimester miscarriage among singleton pregnancies following IVF/ET. A prospective cohort study was conducted in a teaching hospital between December 2017 and January 2020 including women who conceived through IVF/ET. Maternal mean arterial pressure, ultrasound markers including mean gestational sac diameter, fetal heart activity, crown rump length and mean uterine artery pulsatility index (mUTPI) and biochemical biomarkers including maternal serum soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), kisspeptin and glycodelin-A were measured at 6 weeks' gestation. Logistic regression analysis was carried out to determine significant predictors of miscarriage prior to 13 weeks' gestation and performance of screening was estimated by receiver-operating characteristics curve analysis. Among 169 included pregnancies, 145 (85.8%) pregnancies progressed to beyond 13 weeks' gestation and had live births whereas 24 (14.2%) pregnancies resulted in a miscarriage during the first trimester. In the miscarriage group, compared to the live birth group, maternal age, body mass index, and mean arterial pressure were significantly increased; mean gestational sac diameter, crown rump length, mUTPI, serum sFlt-1, glycodelin-A, and the rate of positive fetal heart activity were significantly decreased, while no significant differences were detected in PlGF and kisspeptin. Significant prediction for miscarriage before 13 weeks' gestation was provided by maternal age, fetal heart activity, mUTPI, and serum glycodelin-A. The combination of maternal age, ultrasound (fetal heart activity and mUTPI), and biochemical (glycodelin-A) markers achieved the highest area under the curve (AUC: 0.918, 95% CI 0.866-0.955), with estimated detection rates of 54.2% and 70.8% for miscarriage before 13 weeks' gestation, at fixed false positive rates of 5% and 10%, respectively. A combination of maternal age, fetal heart activity, mUTPI, and serum glycodelin-A at 6 weeks' gestation could effectively identify IVF/ET pregnancies at risk of first trimester miscarriage.

Risk factors for missed abortion: retrospective analysis of a single institution’s experience

ObjectiveTo explore the risk factors including the difference between mean gestational sac diameter and crown-rump length for missed abortion.MethodsHospitalized patients with missed abortion and patients with continuing pregnancy to the second trimester from Chengdu Women's and Children's Central Hospital from June 2018 to June 2021 were retrospectively analyzed. The best cut-off value for age and difference between mean gestational sac diameter and crown-rump length (mGSD-CRL) were obtained by x-tile software. Univariate and multivariate logistic regression analysis were adopted to identify the possible risk factors for missed abortion.ResultsAge, gravidity, parity, history of cesarean section, history of recurrent abortion (≥ 3 spontaneous abortions), history of ectopic pregnancy and overweight or obesity (BMI > 24 kg/m2) were related to missed abortion in univariate analysis. However, only age (≥ 30 vs < 30 years: OR = 1.683, 95%CI = 1.017–2.785, P = 0.043, power = 54.4%), BMI (> 24 vs ≤ 24 kg/m2: OR = 2.073, 95%CI = 1.056–4.068, P = 0.034, power = 81.3%) and mGSD-CRL (> 20.0vs ≤ 11.7 mm: OR = 2.960, 95% CI = 1.397–6.273, P = 0.005, power = 98.9%; 11.7 < mGSD-CRL ≤ 20.0vs > 20.0 mm: OR = 0.341, 95%CI = 0.172–0.676, P = 0.002, power = 84.8%) were identified as independent risk factors for missed abortion in multivariate analysis.ConclusionPatients with age ≥ 30 years, BMI > 24 kg/m2 or mGSD-CRL > 20 mm had increasing risk for missed abortion, who should be more closely monitored and facilitated with necessary interventions at first trimester or even before conception to reduce the occurrence of missed abortion to have better clinical outcomes.

Yolk sac size and shape, gestational sac diameter, and embryonic heart rate as prognostic factors of first-trimester pregnancy outcomes

BackgroundYolk sac first appears at ~5 weeks of gestation and is visualized by ultrasound and along with embryonic heart rate can be used as prognostic factors for first-trimester pregnancy outcomes.AimTo evaluate the correlation between each of the ultrasound parameters that were assessed in the first trimester (the gestational sac size, yolk sac size and shape, and embryonic heart rate) and early pregnancy loss and to correlate between different ultrasound parameters with each other.Patients and methodsThis randomized prospective controlled study included 250 pregnant women with singleton pregnancies during the first trimester from 6 to 8 weeks at the Department of Obstetrics and Gynecology and LogiqP3 at the Department of Radiology of Kotor Central Hospital and Chison at Obstetrics and Gynecology Clinic of Menofia University.ResultsIrregular-shaped yolk sac proved to be an important prognostic factor in pregnancy outcome in our study. In the pregnancies that resulted in normal first trimester, there was a significant association between crown-rump length (CRL) and mean gestational sac diameter (P < 0.001) and mean yolk sac diameter (P < 0.001).ConclusionMeasurement of gestational sac diameter, CRL, and fetal heart rate in combination provides a better prediction of the prognosis of the first trimester than when either parameter is used alone.

Using Ultrasound for Pregnancy Failure in Patients with 1st Trimester Recurrent Pregnancy Loss

Background: Pregnancy loss is the interruption and/or termination of pregnancy, either spontaneously or intentionally, before the fetus develops sufficiently to survive. About 80% of abortions occur in the first 12 weeks of pregnancy. Objective: To determine the accuracy of U/S parameters in predicting early pregnancy failure in pregnant with history of 1st trimesteric recurrent pregnancy loss. Patients and methods: This was a prospective study that included 120 pregnant females with history of first trimesteric recurrent pregnancy loss. It was conducted in Obstetrics and Gynecology Department, Menoufia University Hospitals, and Rashid General Hospital, Al-Bahira, Egypt during the period from April 2019 until August 2020. Results: There is no significant difference between miscarriage group and ongoing pregnancy group regarding risk factors and demographic data (p > 0.05). In addition, crown-rump length (CRL) below 5th percentile for gestational age (GA) category more significantly prevalent in the miscarriage group compared to the ongoing pregnancy group. While, mean gestational sac diameter (MGSD) below 5th percentile for GA, caudal displacement of gestational sac (GS) or irregular GS could predict subsequent miscarriage. Embryonic heart rate/Fetal heart rate (EHR/FHR) below 5th percentile for GA was statistically significantly more prevalent in the miscarriage group than in ongoing pregnancy group. Abnormally large YSD (> 95th percentile for GA), absent yolk sac (YS), floating YS, deformed, irregular or hypo-echoic YS could predict subsequent miscarriage. Uterine artery resistance index (RI), pulsatile index (PI) and systolic/diastolic (S/D) ratio did not differ significantly between the miscarriage group compared to the ongoing pregnancy group across the various gestational ages. Conclusion: 1st trimester U/S parameters are useful diagnostic tool to prognosis pregnancy outcome among patients with history of recurrent 1st trimester pregnancy loss.

English

BACKGROUND Early pregnancy failure is stated as noncompatible, intrauterine pregnancy with either an empty gestational sac or a gestational sac that contains an embryo or fetus which does not have any fetal cardiac activity in the initial 12 weeks of the pregnancy. In the assessment of early pregnancy, ultrasound plays a significant role. METHODS A prospective observational study was conducted in a tertiary care hospital between May 2019 and April 2020 among 500 pregnant females fulfilling the inclusion and exclusion criteria. Patient follow up was done by weekly telephonic calls until completing 12 weeks gestation or reporting miscarriage. Also, all patients were followed by the recommended routine ultrasound (US) scanning with or without emergency visits. RESULTS In our study period, 500 women fulfilling the inclusion criteria were included in our study. Out of whom, 85 (17.5 %) women had an early pregnancy failure (before 12 weeks). There was significantly lower mean gestational sac diameter (GSD), crown to rump length (CRL), fetal heart rate (FHR), and P-value &lt; 0.001 in women who experienced early pregnancy failure. In pregnancies where the GSD, CRL, and FHR were below the 5th percentile, early pregnancy failure was a more prone outcome. All pregnancies with FHR below 75 beats per minute ended in failure in the present study. When FHR was less than 128 beats per minute, there was enormous rise in the frequency of pregnancy failure. By comparison, yolk sac diameter (YSD) was a less significant predictor of early pregnancy failure. CONCLUSIONS First-trimester ultrasonographic estimations help in predicting early abortion. Risk appraisal tables dependent on combinations of abnormal parameters could significantly help in identifying abnormal pregnancy from normal pregnancy and could improve prediction rates. KEYWORDS Early Pregnancy Failure, Prediction, Transvaginal Ultrasonography, Ultrasonography

The significance of low first trimester serum progesterone in ongoing early pregnancies presenting as pregnancies of unknown location

ObjectivesThe primary objective of this study was to ascertain whether there is association between low initial serum progesterone, sonographic parameters and clinical outcomes in women presenting with pregnancies of unknown location (PUL), which are found to be ongoing at their follow up scans in the first trimester. Study designThis was a non-interventional retrospective cohort study of 1056 patients spanning a 14-year period, conducted in the Early Pregnancy Unit (EPU) of an inner-city teaching hospital. Patients who had an ongoing singleton first trimester pregnancy after presenting with PUL were identified and categorised as having low progesterone if it was 32 nmol/l or lower. The crown-rump length (CRL), mean gestational sac diameter (MGSD) and gestational sac volume (GSV) were measured when the embryo was first seen, and the pregnancy outcome recorded. ResultsPregnancies with low progesterone tended to have smaller gestational sacs (GS) on follow up scan (p = 0.001) and the sac was smaller than expected for a given CRL (p = 0.000). There was no ultrasound parameter that was characteristic of low progesterone. The observation of a smaller than expected MGSD for a given CRL remained even when only pregnancies with normal outcomes were analysed. Clinical outcome data were available for 854 (80.9 %) women. Overall, 81.4 % (n = 34/43) of pregnancies with low progesterone resulted in livebirth, compared to 91.7 % (n = 744/811) livebirths in pregnancies with higher levels (p = 0.0454). ConclusionPregnancies with low progesterone tend to have a smaller GS compared to those with a higher progesterone, and the GSs are smaller than expected for a given CRL. The current study shows that women with low progesterone at the start of pregnancy remain at higher risk of miscarriage, even when the pregnancy is initially found to be viable in the first trimester. These pregnancies also tend to be associated with the sonographic finding of a smaller GS than expected for a given gestational age, regardless of eventual outcome.

New predictors of early impaired placentation preceding miscarriage before 10 weeks of gestation in IVF pregnancies: A prospective study

IntroductionIn a recent study of 10,011 pregnant women, 95% of miscarriages occurred before routine ultrasound scan at 11–14 weeks. Our study aimed to identify early first trimester parameters which may predict miscarriage before 10 weeks of gestation for in vitro fertilization (IVF) pregnancies. MethodsA cohort of 115 healthy IVF patients with a singleton viable embryo in early first trimester were studied in a tertiary university-affiliated medical center (April 2017–June 2018). Calculations included gestational age (GA); ultrasound evaluation of crown-rump length (CRL), mean gestational sac diameter (GSD) and volume (GSV), mean yolk sac diameter (YSD) and volume (YSV); fetal heart rate (FHR), mean uterine arteries pulsatility index (UtA-PI); and maternal blood placental protein 13 (PP13) levels. Patients were divided into three groups by GA; and early miscarriage versus ongoing pregnancy after GA 10 weeks. ResultsEarly fetal loss occurred in 14.8% of patients; miscarriage group had higher discrepancy between calculated and measured GA (P < 0.001), lower GSD and GSV (P = 0.005 and P = 0.02, respectively), significantly different YSD and YSV, and lower GSD/YSD and GSV/YSV ratios (P = 0.001 and P = 0.003, respectively). UtA-PI/CRL ratio was higher in patients with miscarriage at GA 46–48 days and GA >48 days (P = 0.034 and P = 0.026, respectively). PP13/CRL ratio was higher in patients with miscarriage at GA >48 days (P = 0.041). DiscussionIn IVF pregnancies with live embryo at first ultrasound scan, high UtA-PI/CRL and maternal blood PP13/CRL ratios may indicate impaired placentation preceded early pregnancy loss. A larger cohort is needed to further verify these predictions.

Local intra-gestational sac methotrexate injection followed by dilation and curettage in treating cesarean scar pregnancy.

To assess the safety and efficacy of local intra-gestational sac methotrexate injection followed by dilation and curettage (D&C) in treating cesarean scar pregnancies (CSP). Medical records of CSP patients treated with local intra-gestational sac methotrexate injection followed by dilation and curettage were analyzed at the Maternal and Child Hospital of Guangxi Zhuang Autonomous Region, China. Thirty-one patients were included in this study. The mean gestational age, sac diameter and thickness of the uterine scar were 49.6±7.7days, 1.8±0.6cm and 0.30±0.15cm, respectively. The median pretreatment serum β-human chorionic gonadotropin (β-HCG) level was 40,887mIU/mL, with the 25th and 75th percentiles at 19,852 and 74,552, respectively. The median blood loss during D&C was 20mL with the 25th and 75th percentiles at 10mL and 50mL. Following D&C, a Foley's balloon catheter compression was implanted in 26 (83.9%) patients due to active uterine bleeding. All patients had a β-HCG regression time of ≤ 4weeks after D&C. While 30 patients (96.8%) had a uterine recovery time of ≤ 4weeks, and 29 patients (93.5%) had resumption of menstruation of less than 6weeks. Three patients (9.7%) had complications. One of them suffered from massive vaginal bleeding and underwent s blood transfusion. There were no other complications, such as pelvic infection and uterine rupture during the procedures. And no patient was converted to surgical resection or uterine artery embolization. Overall, 30 patients (96.8%) were treated successfully. Local intra-gestational sac methotrexate injection followed by D&C with the aid of a Foley's balloon catheter compression appears to be a safe and effective treatment for CSP. Further randomized controlled trials are suggested to confirm these findings.

Combination of conservative treatment and temporary bilateral laparoscopic uterine artery clipping with hysteroscopic transcervical resection for cervical pregnancy: A retrospective study

IntroductionWe investigated whether temporary bilateral laparoscopic uterine artery clipping with hysteroscopic transcervical resection (LUA clipping-TCR) is an effective minimally invasive treatment for the management of cervical pregnancy. Materials and methods: This study is a retrospective clinical case series conducted at Teine Keijinkai Hospital from January 2014 to June 2019. Nine cervical pregnancies among 164 ectopic pregnancies were retrospectively examined. The intervention involved performing LUA clipping-TCR on villous tissue. Information on patient characteristics, clinical data, and surgical details was collected from medical records and surgical videos. ResultsThe mean (range) age of the patients was 33 years (29–41 years); and mean gestational sac diameter, 12.8 mm (5–24 mm). Five patients had a history of intrauterine procedures. Three patients had a positive fetal heartbeat. The mean (range) preoperative serum hCG level (mIU/mL), surgical time (min), uterine artery blocking time (min), and amount of surgical blood loss (ml) were 14,040 (2880–41,367), 82 (62–120), 42 (21–68), and 57 (10–200), respectively. The mean decrease in serum hCG level (second postoperative day) and duration until resumption of menstruation were 79.7 % (70–86.7 %) and 46 days (35–80 days), respectively. The hospitalization period was 2–3 days, with no evidence of persistent ectopic pregnancy. Live birth was achieved in four cases. DiscussionOur results confirm previous findings and provide new evidence that LUA clipping-TCR is effective for cervical pregnancy management and fertility preservation, respectively. Future large-scale prospective studies to compare different cervical pregnancy management methods are required.

AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations.

AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations.

Medical management of miscarriage: Predictive factors of success.

Medical management of miscarriage is an acceptable option available to women, and has advantages of providing timely treatment, while avoiding exposure to surgery and anaesthesia. This retrospective cohort study aimed to determine factors predictive of successful medical management, utilising a single dose protocol of 800 µg vaginal misoprostol. In this cohort, the success rate was 67% (199/296), and smaller mean gestational sac diameter independent of gestational age predicted success (P = 0.046). Success is not significantly related to parity, miscarriage type, pelvic pain or vaginal bleeding at the outset of treatment.

Successful Treatment of Cesarean Scar Pregnancy With Suction Curettage: Our Experiences in Early Pregnancy.

Cesarean scar pregnancy is an ectopic pregnancy embedded in the myometrium of a cesarean scar. Several types of conservative treatment have been used to treat cesarean scar pregnancy, but no management protocol has been established for this rare, life-threatening condition. The purpose of this study was to evaluate the feasibility of suction curettage as a first-line treatment in early cesarean scar pregnancy. During a 4-year period, 19 cases of cesarean scar pregnancy were diagnosed at Süleymaniye Maternity Hospital in Istanbul, Turkey. Suction curettage and Foley balloon tamponade were performed as a first-line treatment in 13 patients. Medical records and treatment results of the patients were evaluated. The mean maternal age was 32.5 years (range, 24-39 years). The mean gestational sac diameter was 13.65 mm (range, 7.6-27 mm), and mean endometrial thickness was 10.7 mm (range, 6.7-14.6 mm). A measurable fetal pole for crown-rump length was available for 6 (46.1%) patients. None of the fetuses had cardiac activity. Suction curettage under ultrasound guidance and Foley balloon tamponade were successful as the primary treatment in 13 of 13 patients. No major complications occurred during or after the procedure. Our data suggest that surgical evacuation under ultrasound guidance with Foley balloon tamponade is a safe and successful treatment modality in carefully selected patients with early cesarean scar pregnancy.

The Efficacy of Mean Gestation Sac Diameter Measurement by Ultrasound In Estimating The Gestational Age

The Efficacy of Mean Gestation Sac Diameter Measurement by Ultrasound In Estimating The Gestational Age

Difference between mean gestational sac diameter and crown-rump length as a marker of first-trimester pregnancy loss after in vitro fertilization

To investigate whether the difference between mean gestational sac diameter and crown-rump length (mGSD - CRL) is associated with first-trimester pregnancy loss or adverse pregnancy outcomes after invitro fertilization (IVF) and to determine if mGSD - CRL is a better predictor of pregnancy loss than either measurement alone. Retrospective cohort study. University hospital. A total of 1,243 IVF cycles with fresh or cryopreserved autologous embryo transfers resulting in singleton gestations performed at the University of Iowa Hospitals and Clinics from January 2005 through December 2014. Cycles included ultrasound measurements of mGSD and CRL at 45-56days' gestation. Mean gestational sac diameter to crown-rump length difference. Primary outcomes were first-trimester pregnancy loss and gestational age at delivery. Secondary outcomes were infant birth weight and pregnancy complications. First-trimester pregnancy loss rates were significantly higher in pregnancies with mGSD - CRL <5mm (43.7%) compared with 5-9.99mm (15.8%), 10-14.99mm (9.9%), and ≥15mm (7.1%). No correlations were found with infant birth weight, gestational age at delivery, or other pregnancy complications. mGSD - CRL was not a better predictor of pregnancy loss than mGSD or CRL alone. There is a strong inverse relationship between mGSD - CRL and first-trimester pregnancy loss in IVF patients, although the incidence of pregnancy loss with a mGSD - CRL <5mm was significantly lower than previously reported. Small mGSD - CRL was not associated with an increased risk of complications in pregnancies that continued beyond 20weeks. The association between mGSD, CRL, and miscarriage is complex.

Ultrasound prediction of spontaneous abortions in live embryos in the first trimester

Introduction:To generate a prediction model for miscarriage in women with a viable single pregnancy from first-trimester ultrasound findings and maternal characteristics.Material and Methods:A prospective, cross-sectional study of 415 singleton pregnancies was performed. The initial ultrasound parameters were crown-rump length (CRL), mean gestational sac diameter (MGSD), yolk sac diameter (YSD), and the sum of the differences between gestational ages and embryonic heart rate (EHR). Potential predictors for spontaneous miscarriage occurring prior to 20 weeks were evaluated.Results:Fifty-three (12.8%) patients had miscarriages and 362 (87.2%) had normal outcomes. Forty-three (81.2%) miscarriages occurred in the first trimester, 5 (9.4%) in the second trimester, and 5 (9.4%) represented fetal anomalies. EHR, CRL, and MGSD were decreased in the miscarriage group (p<0.001); YSD showed no difference (p=0.21). Gestational age by CRL and by MGSD were different between the groups (p<0.001). The proposed sum of differences was higher in the miscarriage group (p<0.001). Maternal age, indication for scan, gestational age by MGSD and CRL, heart rate, and proposed sum of differences were found to be potential predictors. Predictive ability of our proposed model was calculated sensitivity as 0.509, and specificity as 0.975 with a cut-off=0.5. The prediction model’s false positive rate is 0.025, and its false negative rate is 0.491.Conclusions:Miscarriage can be predicted via maternal characteristics and ultrasound findings. Advancing maternal age, low EHR, and high proposed sum of differences increase the probability of miscarriage.

Maternal serum markers in predicting successful outcome in expectant management of missed miscarriage

The aim of this study was to evaluate the use of biological serum markers, available routinely in most hospital clinical laboratories, in predicting successful outcomes of expectant management in women presenting with a missed miscarriage. This is a single centre observational prospective study over a 16-month period. Among the 490 women who consented to the study protocol, 83 presented with missed miscarriage during the first trimester of pregnancy and opted for expectant management. The mean gestation sac diameter and volume of the gestation sac were recorded during ultrasound examination. Maternal serum samples were obtained in each case and assayed for human chorionic gonadotrophin, progesterone, pregnancy associated plasma protein A (PAPP-A) and high-sensitivity C-reactive protein using commercial assays. When examined individually, maternal age (P = 0.01), progesterone (P = 0.03) and PAPP-A (P = 0.02) were all significantly associated with successful expectant management. Increased maternal age was associated with an increased chance of success with the odds of success increased by around 75% for a 5-year increase in age. Higher values of progesterone and PAPP-A were associated with a reduced chance of successful management. Low maternal serum progesterone concentration was the strongest parameter associated with a successful spontaneous completion of miscarriage.