Objectives: To assess the prognostic value of smaller than expected early Crown-rump length (CRL) to predict the occurrence of subsequent first trimester miscarriage in women with singleton pregnancy conceived by in vitro fertilisation treatment with or without intracytoplasmic sperm injection (IVF/ICSI). Methods: A retrospective observational study of prospectively collected data of first trimester intra-uterine singleton pregnancies after an IVF/ICSI fresh cycle was conducted at a tertiary centre where embryonic transfer is performed at the cleavage stage. Real gestational age (GA) in days was calculated from the date of oocyte retrieval (plus 14 days). CRL was measured at 6 to 10 weeks by transvaginal ultrasound and only pregnancies viable at this stage were considered. GA from CRL, termed estimated GA, was calculated by the software (Astraia ®) in use. Discrepancy in days between real and estimated GA was compared between viable and miscarried pregnancies at 11-13 weeks. First trimester miscarriage rate was assessed according to cutoffs (-3,-5 and-7 days of estimated GA). Results: From 282 pregnancies, 256 (90.8%) were viable at 11 to 13 weeks. Miscarried pregnancies had greater discrepancy between real and estimated GA than viable pregnancies (-3.029 days [-4.756 to-1.302], p=0.001). Late first trimester miscarriage occurred in 12/37 (32%) of pregnancies when estimated GA was-3 days than real GA, in 7/12 (58%) when it was-5 days and in 4/7 (85%) when it was-7 days. Miscarriage rate was not influenced by maternal age (p=0.866) nor fertilisation treatment (IVF versus ICSI, p=0.824). Conclusions: There appears to be an association between a smaller than expected early CRL and a higher likelihood of first trimester miscarriage in singleton pregnancies conceived by IVF/ICSI. This data can be useful in clinical practice to assist in the decision of a re-evaluation by early scan. OP11.04 Should the beta hCG threshold level for ultrasound in the diagnosis of tubal ectopic pregnancies be abolished?
This study found a significant relation between YS abnormalities and embryonic morphology in missed miscarriage cases. This was most evident with abnormalities in YS diameter rather than the YS shape or appearance. The commonest combinations met in our cases were growth disorganized 1 embryos with an absent YS, normal embryonic morphology with normal or small YS, and isolated embryonic defects with cystic YS.
After 24 gestational weeks, SP4 assessment is a simple and reliable promising tool to predict spontaneous PTB among asymptomatic high-risk women, with a little superior performance than CL measurement.
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