Early pregnancy ultrasound measurements and prediction of first trimester pregnancy loss: A logistic model

Abstract

Our objective was to prospectively validate the use of gestational sac (GS), yolk sac (YS) diameter, crown-rump length (CRL), and embryonal heart rate (HR) dimensions to identify early pregnancy loss. This was a prospective cohort study of first trimester pregnancies. GS and YS diameter, CRL, and HR measurements were serially obtained in singleton and twin pregnancies from 6 through 10 weeks’ gestation. Non-parametric tests and logistic regression models were used for comparisons of distributions and testing of associations. A total of 252 patients were included, of which 199 were singleton pregnancies, 51 were twins, and 2 were triplets (304 total fetuses). Fifty-two patients had 61 losses. We built nomograms with the changes of the parameters evaluated in ongoing, as well as in pregnancy loss. In the pregnancies which failed, all the parameters showed significant changes, with different temporal onsets: GS and YS were the first to become abnormal, deviating from normality as early as 6 weeks’ gestation (OR 0.01, 95% CI 0.0–0.09, and OR 3.36, 95% CI 1.53–7.34, respectively), followed by changes in HR, and CRL, which became evident at 7 and 8 weeks (OR 0.96, 95% CI 0.92–1.0, and OR 0.59, 95% CI 0.48–0.73, respectively). Our observations showed that, after 5 complete weeks’ gestation, a small GS and a large YS reliably predicted pregnancy loss. The YS reliably identified the occurrence of a miscarriage at least 7 days prior its occurrence. CRL and HR became abnormal at a later time in pregnancy and closer to the event. These findings have important implications for patient counseling and care planning, as well as a potential bearing on cost effectiveness within early pregnancy care.

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

“…For this reason, the presence of CRL  5 th percentile for GA could predict subsequent miscarriage. Also, Detti et al (8) reported that the deterioration in progressive increase in the CRL signify miscarriage of pregnancies in their group of women, which runs in line with our results. Radwan et al (9) found that there was no significant difference between miscarriage group and ongoing pregnancy group regarding CRL, which is conflicting with our results.…”

“…Our study results agree‫س‬ with Detti et al (8) who demonstrated that there was no statistical difference regarding maternal age and BMI that signify miscarriage. Also, Radwan et al (9) found that there was no statistical difference regarding maternal age and BMI that signify miscarriage.…”

Impact of location on placentation in live tubal and cesarean scar ectopic pregnancies

“…Smaller CRL [22,28] and lower fetal heart rate (24,28,29] for gestational age have also been reported in pregnancies that subsequently miscarried whereas in those cases the yolk sac size has been described as normal [24], decreased [29] or increased [25,30,31]. The gestational sac and yolk sac sizes starts deviating from normality as early as 6 weeks of gestation followed by changes in CRL and fetal heart rate at 7 and 8 weeks [26]. In the present study, we found a significantly (P <.001) higher incidence of GSD < 5 th centile for gestational age (Table 1) and median gestational sac size (Table 2) in TEPs than in CSPs.…”

“…Overall, in women with known last menstrual period in spontaneous pregnancies or known date of ovulation or embryo transfer in pregnancies resulting from ART, a smaller than expected GSD has been reported by all authors as predictive of subsequent miscarriage despite a normal fetal cardiac activity [21][22][23][24][25][26][27]. Smaller CRL [22,28] and lower fetal heart rate (24,28,29] for gestational age have also been reported in pregnancies that subsequently miscarried whereas in those cases the yolk sac size has been described as normal [24], decreased [29] or increased [25,30,31].…”

Detection and significance of main anchoring villus in early pregnancy

“…Measurement of the distance from the most cephalad to the most caudal extremities to obtain the CRL of the embryo was performed in the maximum long-axis or median sagittal section, with the embryo in a naturally extended position. 10 Routine transabdominal nuchal translucency tests were performed on women who met the criteria for nuchal translucency screening (CRL ≥ 45 mm).…”