Diagnosis Of Miscarriage Research Articles

Paternal Smoking Exposure and Risk of Miscarriage, in a Population Exposed to Organochlorines

P-363 Introduction: Studies about paternal smoking exposure have reported inconsistent findings regarding the risk of miscarriage, probably due the existence of few prospective studies and the lack of potential environmental confoundings. Methods: As a part of a cohort study aimed to evaluate organochlorine exposure and infant neurodevelopment, 1000 healthy women were recruited during pre-nuptial counseling required to obtain a marriage license in Mexico. From 300 pregnancies, a nested case control study comprised 20 women with diagnosis of miscarriages (<20 weeks) and 73 matched (on last menstrual date ± 15 days) control women whose pregnancies survived beyond week 20 was carried out. All women and their husbands were interviewed about socio-economical and reproductive characteristics, smoking (yes/no) and alcohol habits and occupation during the last three years before of pregnancy for men and during pregnancy for women. Maternal organochlorines serum levels were available for this report. Odds ratio and 95% CI were estimated by conditional logistic regression model. Results: Average gestational age at miscarriage was 10 weeks (range: 6–17 weeks). 82.4% of women were primigravidae. Proportion of paternal smoking habits was 53%; meanwhile only 23.5% of women reported have been smoking during the first trimester of pregnancy. Crude OR for paternal smoking habits and miscarriage was OR=3.4, 95%CI (1.1, 10.1). After multivariate adjustment by periconceptional p,p’-DDE maternal serum levels and paternal occupation, the odds ratio for miscarriage was 2.9 95% CI (0.96, 9.2) (p=0.06). Discussion and Conclusion: These results suggest that paternal smoking plays an important role in the risk of miscarriage independently of paternal occupation and maternal organochlorine exposure. Since no clear mechanism (direct sperm damage and/or through maternal passive exposure) is described for this effect, antismoking policy should target couples during preconceptional period.

Ultrasound in acute gynecological care—two steps forward, one step back

Ultrasound in acute gynecological care—two steps forward, one step back

Risk Factors for Spontaneous Abortion in Early Symptomatic First-Trimester Pregnancies

To evaluate the association of an ultimate diagnosis of miscarriage with various clinical symptoms and historical factors in a cohort of women presenting with pain, bleeding, or both in the first trimester of pregnancy. This was a case-control study from a population of women presenting for care with pelvic pain or vaginal bleeding in the first trimester of pregnancy whose diagnoses were not definite upon initial evaluation. Analyses were performed in 2 ways. In one instance cases were defined as women ultimately definitively diagnosed with a miscarriage and controls were defined as women with a pregnancy that did not result in miscarriage (ectopic pregnancy or ongoing intrauterine pregnancy). The second analysis compared women with a miscarriage only to women who had an ongoing intrauterine pregnancy. A total of 2,026 women were evaluated, with 1,192 ultimately diagnosed with a spontaneous abortion, 367 with ectopic pregnancy, and 467 with a viable intrauterine pregnancy. Although many risk factors were individually associated with miscarriage in preliminary analysis, in the final analysis only extremes in age (< 25 and > 35) and the complaint of bleeding (odds ratio [OR] 7.35, 95% confidence interval[CI] 5.74-9.41) were associated with miscarriage. The complaint of pain (OR 0.72, 95% CI 0.57-0.92), human chorionic gonadotropin (hCG) value greater than 500 (hCG < or = 500 IU/mL compared with hCG 501-2000: OR 0.52, 95% CI 0.39-0.69) and concurrent cervical infection (OR 0.69, 95% CI 0.55-0.88) were negatively associated with miscarriage. Few factors predict miscarriage in women who present with a symptomatic first trimester pregnancy of unknown location. Heavy bleeding was most strongly associated with miscarriage. Concurrent cervical infections should not be overlooked as a cause of bleeding in early pregnancy and were not associated with miscarriage. II-2.

Expectant management of miscarriage—prediction of outcome using ultrasound and novel biochemical markers

The aim of this study was to examine the value of various ultrasound and biochemical parameters for the prediction of successful expectant management of miscarriage. This was a prospective observational study. Clinically stable women with an ultrasound diagnosis of miscarriage were offered expectant management. In all cases, gestational age, size of retained products of conception, serum HCG, progesterone, 17-hydroxyprogesterone, insulin growth factor-binding protein 1 (IGFBP-1), inhibin A and inhibin pro alpha-C RI levels were recorded. Follow-up continued until resolution of the pregnancy. Clinical data, ultrasound findings and biochemical markers were analysed using univariate analysis and decision tree analysis. Fifty-four women underwent expectant management of miscarriage. Thirty-seven (69%) had successful expectant management and 17 (31%) required surgery. The size of retained products, serum HCG, progesterone, inhibin A and inhibin pro alpha-C RI were all significantly different in those pregnancies that resolved spontaneously (P<0.05). Serum inhibin A was the best predictor of a complete miscarriage. This study shows that novel biochemical markers may be used to predict the likelihood of successful expectant management of miscarriage.

First-trimester, three-dimensional transvaginal ultrasound volumetry in normal pregnancies and spontaneous miscarriages.

The aim of this study was to perform three-dimensional ultrasound volumetry of intrauterine contents in cases of normal and failed pregnancies and correlate these with conventional two-dimensional measurements. This was a cross-sectional observational study. Three-dimensional volumetric data were collected from a total of 111 patients with first-trimester singleton pregnancies together with conventional two-dimensional measurements. A single investigator performed all ultrasound scans and volume measurements. Among 111 participants, 30 had an ongoing pregnancy and 81 had a miscarriage (anembryonic pregnancy 30, missed miscarriage 30, and incomplete miscarriage 21). There were no significant differences in age, parity, or gestational age between groups. A positive linear correlation was demonstrable between the crown-rump length and gestational sac volume in normal pregnancies (r = 0.962) and between gestational sac volume and gestational age, but the correlation was weaker in cases of missed miscarriage (r = 0.561). The volume of the retained products of conception as measured by three-dimensional ultrasound volumetry in cases of incomplete miscarriage also showed a strong linear correlation (r = 0.938) to their maximum anterior-posterior diameter. There was an exponential correlation between the mean gestational sac diameter and gestational sac volume and the crown-rump length and embryonic volume in cases of both normal and failed pregnancies. The mean gestational sac diameter:crown-rump length ratio (P = 0.008) and gestational sac volume:embryonic volume ratio (P = 0.023) in missed miscarriages were significantly higher than those in ongoing pregnancies. Three-dimensional ultrasound volumetry of intrauterine contents in normal and failed pregnancies correlates well with conventional two-dimensional measurements. Volumetric assessment does not seem to improve the diagnosis of miscarriage. However, its potential to predict pregnancies that will fail and determine the appropriate management regime for individual patients merits further research.

Prediction of pregnancy outcome in women with an empty gestational sac on ultrasound scan

Background: The ultrasound finding of an empty gestational sac may represent either an early normal pregnancy or a missed miscarriage, and follow up visits are usually required to reach a correct diagnosis. The aim of this study was to examine whether a combination of ultrasound and other clinical data may help to predict the final outcome at the initial visit.Methods: In all women with a diagnosis of an empty sac on transvaginal ultrasound scan, a detailed clinical history was obtained and a blood sample was taken to measure serum human gonadotrophin and progesterone levels. They were managed expectantly and invited to attend for a follow up scan 1 week later. The presence of a live embryo at follow up scan was used to diagnose normal pregnancy, whilst the diagnosis of miscarriage was made if the embryo remained undetectable, and/or the gestational sac showed regressive changes.Results: A number of 197 women were included into the final analysis, 115 (58%) of whom had a normal pregnancy and 82 (42%) had a missed miscarriage. Women with normal pregnancies were significantly younger (P &lt; 0.01), less likely to present with vaginal bleeding (P &lt; 0.001), had smaller gestational sacs (P &lt; 0.001) and higher serum progesterone (P &lt; 0.001) than those women who had missed miscarriages. On inspecting the ROC curves, serum progesterone was the best test to discriminate between viable and nonviable pregnancies. Using a cut‐off of 25 nmol/L a viable pregnancy could be diagnosed with 100% sensitivity and 45% specificity.Conclusion: Serum progesterone can be used to differentiate between normal and abnormal pregnancies in women with the diagnosis of an empty sac on ultrasound scan. This may help to improve patient's counseling and significantly reduce the need for follow up visits in women with nonviable pregnancies.

Case report: serial serum HCG measurements in a patient with an ectopic pregnancy: a case for caution.

Improvements in the use of ultrasound in early pregnancy have resulted in improved diagnosis of miscarriage and ectopic pregnancy. There are still, however, a significant number of women with a suspected abnormal pregnancy, where transvaginal ultrasound is unable to locate the pregnancy. The concern is the possibility of ectopic pregnancy. An alternative diagnostic tool is required and it has been suggested that it is possible to monitor serum beta human chorionic gonadotrophin. The present case highlights the potential dangers of this management.

Miscarriage diagnosis and gestational age estimation in the early first trimester of pregnancy: transabdominal versus transvaginal sonography.

A comparison is made between 290 patients examined using transabdominal sonography and 308 patients examined using transvaginal sonography. Patients with suboptimal menstrual histories and threatened miscarriages were excluded from these two groups of patients. The transabdominal and transvaginal sonography examinations were carried out while the patient's bladder was empty, so that there was no delay between the clinical and sonographic examinations. In this way there was no patient discomfort from a full bladder. In normal pregnancies after 42 days of amenorrhea, the percentage visualization rates of the chorionic sac, of the embryo with heart activity and of the yolk sac were measured. There were no significant differences between the two groups. The two techniques were able to provide a reliable diagnosis of miscarriage on embryos >or= 4 mm or with chorionic sacs >or= 10 mm mean diameter. However, before 42 days of gestation, transvaginal sonography was better than transabdominal sonography at diagnosing miscarriage. The percentage of anembryonic pregnancies was higher in the transabdominal sonography group (21%) than in the transvaginal sonography group (7%), despite similar gestational ages at the time of a positive diagnosis. Thus, a transabdominal scan can be used after 42 days and borderline cases can be referred for transvaginal sonography for confirmation.