Prediction of successful expectant management of first trimester miscarriage: Development and validation of a new mathematical model

Casikar, I.; Lü, Chuan; Reid, S.; Condous, G.

doi:10.1111/ajo.12053

Cited by 11 publications

(10 citation statements)

References 11 publications

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“…10,17,20 This has led to the research for predictors for successful expectant management with lesser complications. [18][19][20][21][22][23] Vaginal bleeding at presentation, maternal age and early gestational age were found positively correlated to successful expectant management. [18][19][20][21] Diagnosis of incomplete miscarriage at primary scan reported higher success rates than those that included only women with missed or anembryonic pregnancy loss.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16][17] This has led investigators to study about different selection criteria which could reliably predict the likelihood of a complete spontaneous resolution of pregnancy. [18][19][20][21][22][23] Proper selection of cases for expectant management of early pregnancy miscarriages could result in higher success rate with lesser complications thereby increasing its acceptability. [20][21][22][23] This study was to investigate difference in success rate and complication in expectant management of early pregnancy miscarriages with regard to the type of miscarriage: anembryonic pregnancy, early fetal demise and incomplete miscarriage.…”

Section: Introductionmentioning

confidence: 99%

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Expectant management of incomplete miscarriage, anembryonic pregnancy and early fetal demise: a comparative study

Sajan¹,

Mumtaz²,

Chandrika³

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Background: Expectant management as first line management of early pregnancy miscarriages is less accepted due to failure and increased complications reported in few studies. Proper selection of cases improves outcome of expectant management. Aim of this study was to compare success rate and complications in expectant management in three groups of early pregnancy miscarriages- Incomplete miscarriage, anembryonic pregnancy and early fetal demise.Methods: Prospective observational study conducted in tertiary care centre for 3 years, including 107 patients with USG confirmed pregnancy miscarriage <13 weeks. Patients preferring expectant management were managed as outpatient without intervention for 2 weeks after which repeat USG was done to ascertain complete miscarriage. Failed expectant management patients underwent planned surgical uterine evacuation. Emergency admission and evacuation was done, if symptomatic during waiting period. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed and compared in subgroups of anembryonic pregnancy, early fetal demise and incomplete miscarriage. Statistical analysis was done by chi-square test.Results: Incomplete miscarriage group had highest success rate of 88.46%. followed by anembryonic pregnancy (72.5%) and EFD (47.83%) p value = 0.007. Complication rate was highest in EFD, followed by anembryonic and the least in incomplete miscarriage all of which was statistically significant except vaginal bleeding.Conclusions: Expectant management should be offered as first line choice for all types of early pregnancy miscarriages. Proper selection of case as to type of miscarriage especially incomplete miscarriage and selected cases of anembryonic pregnancy and EFD ensures higher success rate with lesser complications. Reserving medical and surgical management for unsuitable/failed cases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Expectant management of incomplete miscarriage, anembryonic pregnancy and early fetal demise: a comparative study

Sajan¹,

Mumtaz²,

Chandrika³

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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“…Papaioannou et al [30] reported that first trimester bleeding increased the risk of PTL. Other previous studies [31,32] showed that the possibility of PTL is more in pregnant women with the first trimester bleeding due to many placental disorders.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography and Pregnancy Outcome in Threatened Abortion: A Prospective Observational Study

Farag¹

2018

Gynecol Obstet

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Aim: To evaluate the role of ultrasound (US) as a predictor of pregnancy outcome in cases with threatened miscarriage. Introduction: First trimester bleeding is a common anxious medical disorder. It may end with pregnancy loss or lead to adverse maternal and fetal outcomes. Certain sonographic parameters like (GSD, YSD, CRL, and FHR) could predict these outcomes. Material and methods: A prospective study involving 500 women in their first trimester was divided into three groups: group I (130 women) in whom threatened abortion ended in abortion, group II (170 women) with threatened abortion and completed their pregnancy and group III (200 women) with normal pregnancy. US indicators included Gestational Sac Diameter (GSD), Yolk Sac Diameter (YSD), Crown-Rump Length (CRL), and Fetal Heart Rate (FHR). These patients were evaluated for the pregnancy outcomes. Results: A significant difference was found between group I and the other two groups regarding FHR and CRL (P<0.05), while no significant difference was observed among the three groups regarding GSD or YSD. Compared to control group, the cases of group II had a higher incidence of premature rupture of membrane PROM (OR=9.9, P<0.05), gestational hypertension (OR=5.4, P<0.05), and placental abruption (OR=4.8, P<0.05). Conclusion: FHR and CRL are good sonographic markers to predict pregnancy outcome in women with threatened miscarriage. FHR at 115 beat/minute yields the best predictivity and CRL at 22 mm yields the least predictive accuracy.

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“…A mathematical model to predict successful expectant management of missed and incomplete miscarriages was validated in a recent prospective study (Casikar et al, 2013). The data were separated into three groups; missed miscarriage, anembryonic sac and incomplete miscarriage, and the authors found that the most independent prognostic variables for their model are the type of miscarriage at primary scan, vaginal bleeding and maternal age.…”

Section: Discussionmentioning

confidence: 99%

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

Memtsa

Jauniaux

Gulbis

et al. 2017

Reproductive BioMedicine Online

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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.

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Prediction of successful expectant management of first trimester miscarriage: Development and validation of a new mathematical model

Abstract: We have developed and validated a new mathematical model to predict successful management of first trimester miscarriage.

Cited by 11 publications

References 11 publications

Expectant management of incomplete miscarriage, anembryonic pregnancy and early fetal demise: a comparative study

Expectant management of incomplete miscarriage, anembryonic pregnancy and early fetal demise: a comparative study

Ultrasonography and Pregnancy Outcome in Threatened Abortion: A Prospective Observational Study

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

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