Prediction of spontaneous miscarriage risk by the use of first trimester ultrasound measurements and maternal serum progesterone level at the 7th week of pregnancy

El-Mekkawi, Sherif F; El-Shahawy, Hazem F; Alyamni, Osama Mohamed

doi:10.1016/j.mefs.2014.04.006

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…There were ten studies that investigated fetal bradycardia in predicting miscarriage (18)(19)(20)(21)(22)(23)(24)(25)(26)(27) and included asymptomatic women and those with vaginal bleeding (N=1762) (Fig. 3a).…”

Section: Fetal Bradycardiamentioning

confidence: 99%

“…Five studies with 1136 women investigated the use of CRL for the prediction of miscarriage (20,21,23,28,29) (Fig. 6a).…”

Section: Crlmentioning

confidence: 99%

“…A subgroup analysis was performed on women with vaginal bleeding (three studies; N= 595) (21,23,29) and asymptomatic women (two studies; N= 541) (20,28). No significant difference in the sensitivity and specificity was noted between the two groups.…”

Section: Crlmentioning

confidence: 99%

“…Two studies (N=349 women) evaluated the MGSD minus CRL difference (MGSD-CRL) in the prediction of miscarriage in women with confirmed fetal viability. These had a sensitivity range of 39% -96% and a specificity range of 73% -88% (20,21).…”

Section: Crl)mentioning

confidence: 99%

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Prediction of miscarriage in women with viable intrauterine pregnancy—A systematic review and diagnostic accuracy meta-analysis

Pillai

Konje

Richardson

et al. 2018

European Journal of Obstetrics & Gynecology and Reproductiv

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Both ultrasound and biochemical markers either alone or in combination have been described in the literature for the prediction of miscarriage. We performed this systematic review and meta-analysis to determine the best combination of biochemical, ultrasound and demographic markers to predict miscarriage in women with viable intrauterine pregnancy. The electronic database search included Medline (1946-June 2017), Embase (1980-June 2017), CINAHL (1981-June 2017) and Cochrane library. Key MESH and Boolean terms were used for the search. Data extraction and collection was performed based on the eligibility criteria by two authors independently. Quality assessment of the individual studies was done using QUADAS 2 (Quality Assessment for Diagnostic Accuracy Studies-2: A Revised Tool) and statistical analysis performed using the Cochrane systematic review manager 5.3 and STATA vs.13.0. Due to the diversity of the combinations used for prediction in the included papers it was not possible to perform a meta-analysis on combination markers. Therefore, we proceeded to perform a meta-analysis on ultrasound markers alone to determine the best marker that can help to improve the diagnostic accuracy of predicting miscarriage in women with viable intrauterine pregnancy. The systematic review identified 18 eligible studies for the quantitative meta-analysis with a total of 5584 women. Among the ultrasound scan markers, fetal bradycardia (n=10 studies, n=1762 women) on hierarchical summary receiver operating characteristic showed sensitivity of 68.41%, specificity of 97.84%, positive likelihood ratio of 31.73 (indicating a large effect on increasing the probability of predicting miscarriage) and negative likelihood ratio of 0.32. In studies for women with threatened miscarriage (n=5 studies, n=771 women) fetal bradycardia showed further increase in sensitivity (84.18%) for miscarriage prediction. Although there is gestational age dependent variation in the fetal heart rate, a plot of fetal heart rate cut off level versus log diagnostic odds ratio showed that at ≤110 beat per minutes the diagnostic power to predict miscarriage is higher. Other markers of intra uterine hematoma, crown rump length and yolk sac had significantly decreased predictive value. Therefore in women with threatened miscarriage and presence of fetal bradycardia on ultrasound scan, there is a role for offering repeat ultrasound scan in a week to ten days interval.

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