The predictive value of first-trimester embryonic heart rates in infertility patients

Qasim, Suna M.; Sachdev, Rahul; Trias, Alexis; Senkowski, Kim; Kemmann, Ekkehard

doi:10.1016/s0029-7844(97)00096-3

Cited by 19 publications

(12 citation statements)

References 13 publications

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“…These findings suggest that decreased EHR and advanced maternal age are independent predictors of fetal demise in the first trimester in infertile women. These results are consistent with other studies investigating EHR in different populations of infertile women (14). Furthermore, a potential interaction between EHR and maternal age was suggested in the data, given that patients with advanced maternal age (>35 years) and EHRs in the 60-110, 111-120, and 121-130 strata had higher overall pregnancy loss rates compared with patients in these EHR categories with maternal age %35 years.…”

Section: Discussionsupporting

confidence: 91%

Embryonic heart rate as a predictor of first-trimester pregnancy loss in infertility patients after in vitro fertilization

Rauch

Schattman

Christos

et al. 2009

Fertility and Sterility

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Section: Discussionsupporting

confidence: 91%

Embryonic heart rate as a predictor of first-trimester pregnancy loss in infertility patients after in vitro fertilization

Rauch

Schattman

Christos

et al. 2009

Fertility and Sterility

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“…In our study the miscarriage rate was 11% in the placebo and 12% in the hCG group, which contrasts with 3.4% miscarriage rate as found by Tannirandorn et al 12 but is broadly in agreement with the 10% incidence of miscarriage at six weeks of gestation found by Makrydimas et al 13 It seems likely that the incidence of fetal loss between 6 and 10 weeks of gestation in threatened miscarriage patients will be dependent upon other factors such as maternal age, smoking habits, amount of vaginal bleeding and at least one repeat USS is necessary for effective diagnostic and prognostic value in such cases. USS findings which are associated with pregnancy loss, after establishing viability of embryo, include discrepancy between the size of the gestational sac and the embryo 14 and fetal bradycardia 15,16 …”

Section: Discussionmentioning

confidence: 99%

“…USS findings which are associated with pregnancy loss, after establishing viability of embryo, include discrepancy between the size of the gestational sac and the embryo 14 and fetal bradycardia. 15,16 The role of a single progesterone measurement in the diagnosis of early pregnancy failure and prognosis of fetal viability has been reported. 17 The sensitivity and specificity attained using a single cutoff level of serum progesterone level above 45 nmol/l was 88%, which may represent improvement over other single tests; however, it does not remove the need for ultrasound or other follow up tests.…”

Section: Discussionmentioning

confidence: 99%

First trimester threatened miscarriage treatment with human chorionic gonadotrophins: a randomised controlled trial

Qureshi

Edi-Osagie

Ogbo³

et al. 2005

BJOG

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Objective To determine whether administration of exogenous human chorionic gonadotrophin (hCG) treatment improve the pregnancy outcome in first trimester threatened miscarriages. Design A prospective, double blind, randomised, placebo-controlled trial.Setting The Early Pregnancy Assessment Unit, Royal Bolton Hospital, Bolton, United Kingdom.Population One hundred and eighty-three women with vaginal bleeding and a viable fetus seen on ultrasound scan (USS) in the first 12 weeks of pregnancy. Methods The patients were randomised to receive either hCG or placebo treatment until 14 weeks of gestation.Main outcome measures The primary objective of the trial was to determine the miscarriage rate in the hCG arm compared from the placebo arm. Results Of the 183 cases, 87 were randomised to treatment with hCG while 96 were randomised to receive a placebo. Forty-seven (25%) did not comply with the study protocol. 5] in the study. The number of patients actively bleeding per vaginum at presentation was 85 (93%) in placebo group and 79 (96%) in the hCG group. The median number of hCG or placebo injections for both groups was 7. Ten women (11%) in the placebo group proceeded to have a complete miscarriage, as did 10 women (12%) in the hCG group, relative risk (RR) [95% confidence interval (CI)] of 1.1 (0.63 -1.6). Conclusion Our study showed no evidence of a difference in the outcome of threatened miscarriages when treated with hCG in the first trimester, this may be because our study sample size was small and follow up was suboptimal. A large, randomised, multicentre trial is still needed to establish the usefulness of hCG treatment in cases of threatened miscarriage.

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“…Abnormal developmental pattern of FHR and/or bradycardia has been associated with subsequent miscarriage87, 96–100. In particular, a slow FHR at 6–8 weeks appears to be associated with subsequent fetal demise91, 98, 101.…”

Section: Ultrasound and The Diagnosis Of Miscarriagementioning

confidence: 99%

The role of ultrasound imaging in diagnosing and investigating early pregnancy failure

Jauniaux

Johns

Burton

2005

Ultrasound in Obstet & Gyne

162

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The advent of high-resolution transvaginal ultrasound (TVS) has revolutionized our understanding of the pathophysiology and the management of early pregnancy failure. Knowledge of the ultrasound appearances of normal early pregnancy development and a good understanding of its pitfalls are essential for the diagnosis and management of early pregnancy failure. Ultrasound imaging has rapidly replaced all other techniques used to study normal human development in the first trimester, and ultrasound features of the early gestational sac have corroborated anatomical studies showing that the first structures to appear are the celomic cavity and the secondary yolk sac. No single ultrasound measurement of the different anatomical features in the first trimester has been shown to have a high predictive value for determining early pregnancy outcome. Similarly, Doppler studies have failed to demonstrate abnormal blood flow indices in the first-trimester uteroplacental circulation of pregnancies that subsequently end in miscarriage. Ultrasound parameters combined with maternal serum hormone levels, maternal age, smoking habits, obstetric history and the occurrence of vaginal bleeding have all been combined in multivariate analyses, with mixed results. Combined ultrasound and in-vitro experiments have demonstrated that the maternal circulation inside the placenta starts at the periphery at around 9 weeks of gestation and that this is associated with a physiological oxidative stress which could be the trigger for the formation of the placental membranes. Abnormal development of these membranes can result in subchorionic hemorrhage and threatened miscarriage with subsequent long-term consequences such as preterm rupture of the membranes and preterm labor, irrespective of the finding of a hematoma on ultrasound. In both euploid and aneuploid missed miscarriages there is clear ultrasound evidence for excessive entry of maternal blood at a very early stage inside the developing placenta resulting in oxidative stress and subsequent degeneration of villous tissue. The finding of blood flow in the intervillous space in cases of first-trimester miscarriage using color Doppler also appears to be useful in the prediction of success of expectant management. Miscarriages with blood flow within the intervillous space are up to four times more likely to complete with expectant management. TVS is considered the gold standard in the diagnosis and management of incomplete miscarriage. Expectant management of miscarriage, using ultrasound parameters to determine eligibility, could significantly reduce the number of unnecessary evacuations of the retained products of conception, depending on the criteria used.

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The predictive value of first-trimester embryonic heart rates in infertility patients

Abstract: First-trimester FHR can help predict pregnancy outcome for infertility patients. Women with FHR outside the reference range from the mean for viable pregnancies at corresponding gestational ages may be at risk for eventual pregnancy loss.

Cited by 19 publications

References 13 publications

Embryonic heart rate as a predictor of first-trimester pregnancy loss in infertility patients after in vitro fertilization

Embryonic heart rate as a predictor of first-trimester pregnancy loss in infertility patients after in vitro fertilization

First trimester threatened miscarriage treatment with human chorionic gonadotrophins: a randomised controlled trial

The role of ultrasound imaging in diagnosing and investigating early pregnancy failure

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