Prediction of abortion using three-dimensional ultrasound volumetry of the gestational sac and the amniotic sac in threatened abortion (original) (raw)
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Asian Journal of Medical Radiological Research, 2019
Background: The introduction of ultrasound into the obstetrical practice has been extremely useful in providing better understanding of the etiology of the first trimester spontaneous abortion and a basis for its clinical classification and management. The aims and objective of this study is to study the ultrasonographic parameters between 6 to 12 week of pregnancy in predicting early abortion, to assess the predictive value of ultrasonographic parameters in predicting early pregnancy and to study the associated maternal factor in present pregnancy in predicting early pregnancy loss. Subjects and Methods: The study included 120 patients attending OPD/emergency within 6-12 weeks of gestation, fulfilling the exclusion and inclusion criteria. Results: Out of 120 pregnancies, 24 pregnancies were non viable, out of which 41.66% were >30years of age. 62.5% of abortions occurred at 8-12 weeks of gestation. 17.5% females had abnormal gestation sac diameter, 6.60% females had abnormal crown rump length, 9.70 % females had abnormal yolk sac and 1 % had abnormal fetal heart rate. Conclusion: This study demonstrated that sonographic parameters, such as abnormal gestational sac diameter, small or large yolk sac diameter, abnormal Crown rump length and decreased fetal heart rate are associated with an increased likelihood of miscarriage. Combining these parameters may provide improved prediction of miscarriage.
Transvaginal ultrasound in threatened abortions with empty gestational sacs
International Journal of Gynecology & Obstetrics, 1994
The aim of this study was to compare the efficacy of vaginal misoprostol loading dose regimen with non-loading dose regimen for termination of second-trimester pregnancy with live fetuses. Material and Methods: A randomized controlled trial was conducted on pregnant women with a live fetus at 14-28 weeks. The patients were randomly allocated to receive either the vaginal misoprostol loading dose regimen (600 mcg, then 400 mcg every 6 h) or the non-loading dose regimen (400 mcg every 6 h). Failure to abort within 48 h was considered to be a failure. Results: Of 157 recruited women, 77 were assigned to be in group 1 (loading group) and 80 were in group 2 (non-loading group). The median abortion time was not statistically different between the groups (14.08; 95% confidence interval: 12.45-17.77 h and 14.58; 95% confidence interval: 12.8-17.27 h, P > 0.05). The rates of abortion within 24 h and 48 h were also comparable between the groups. Fever and chills were more common in the loading group. No other serious complications, such as postpartum hemorrhage and uterine rupture, were found. Conclusion: Vaginal misoprostol in the loading dose regimen had a similar efficacy to the non-loading dose regimen but was associated with more adverse maternal effects.
Contraception, 2010
Background: We sought to establish the accuracy of abdominal ultrasonography in determining gestational age and identifying the presence of a gestational sac and embryonic pole before and after medical abortion. Methods: We included all 120 women enrolled in a study of simultaneous oral mifepristone and buccal misoprostol for abortion through 63 days' gestation. Vaginal and abdominal ultrasound examinations were performed before and 24 h after medication administration. Visualization of a gestational sac and embryonic pole and presence or absence of cardiac activity were recorded. Sensitivity and specificity were calculated with the results from vaginal ultrasonography as the gold standard. The effect of body mass index (BMI) on ultrasound findings was also assessed. Results: Before treatment, the sensitivities of abdominal ultrasonography were 100% (95% CI 97-100) and 68% (95% CI 58-77) for presence of a gestational sac and an embryonic pole, respectively. Overall, abdominal imaging underestimated mean gestational age by 1.6 days (95% CI 1.0-2.2). After treatment, abdominal ultrasonography missed three of 34 retained gestational sacs (sensitivity 91%, 95% CI 76-98%). Fourteen women had gestational cardiac activity by vaginal ultrasound at follow-up. Abdominal imaging identified the gestational sac in all cases, but cardiac motion was only visible in 10 (71%, 95% CI 42-92%). For every 10-point increase in BMI, the odds ratio for missing an embryonic pole at baseline was 2.8 (95% CI 1.5-5.0). Conclusions: Abdominal ultrasonography is sensitive for diagnosing the presence or absence of a gestational sac, but less sensitive at detecting an embryonic pole. This may lead to a small underestimation of gestational age and missing a continuing pregnancy at follow-up when one exists.
Objectives: The study examines the pregnancy outcome in patients with threatened abortion and patients with abnormal early sonography markers. from 2012 to 2014. Women with threatened abortion and abnormal early sonography markers were included in the study that fulfilled the inclusion criterias. Women with normal sonography markers were taken as control. Conclusions: Transvaginal sonography should be used adequately to look for early pregnancy markers like Size of Gestational sac, size and shape of yolk sac, fetal heart rate and in cases of threatened abortion presence of subchorionic haematoma and its size because all these markers are good predictors of pragnacy outcome and can prove helpful in patient counseling.
Sonographic patterns of the endometrium in assessment of medical abortion outcomes, 2013
Background: We aimed to define endometrial pattern and endometrial thickness in predicting the outcome of early medical abortion. Study Design: While blinded to outcomes of abortion, we retrospectively reviewed the ultrasound scan performed 14–21 days after medical abortion. We assessed the endometrial pattern and endometrial thickness. A total of 943 women at or before 56 days of gestation who underwent medical abortions were included. Abortion was induced with mifepristone (600 mg) orally followed 48 h later with oral misoprostol (600 mcg). A successful medical abortion was defined as complete abortion without surgical intervention. Three sonographic patterns (homogenous, heterogeneous and multilayered) were devised to correlate with the outcome. Results: Of the 940 women, 92 (9.8%) had failed medical abortions. Eighty-seven (94.6%) patients with failed treatment outcomes had a heterogeneous pattern, while no patients with failed treatments had a multilayered pattern. Based on multivariable logistic regression, women who had an endometrial thickness in the range of 10–15 or N15 mm were more likely to have failed outcomes than those with a thickness b10 mm, with ORs of 3.69 (p=.001) and 8.82 (pb.001). Compared to those with a homogenous pattern, women with a heterogeneous endometrial pattern were more likely to have failed outcomes (OR 4.5, p=.003). In addition, an endometrial thickness N10 mm in combination with a heterogeneous pattern had the highest balanced accuracy in the prediction of failed outcome (81.9%; 95% CI, 77.6–86.3). Conclusion: Women with a multilayered pattern could be reassured that they have successful medical abortion, while those with a heterogeneous pattern and/or endometrium N10 mm may need follow-up. Sonographic endometrial pattern and endometrial thickness may serve as objective criteria in the management of early medical abortions
Contraception, 2007
Background: We sought to establish the accuracy of abdominal ultrasonography in determining gestational age and identifying the presence of a gestational sac and embryonic pole before and after medical abortion. Methods: We included all 120 women enrolled in a study of simultaneous oral mifepristone and buccal misoprostol for abortion through 63 days' gestation. Vaginal and abdominal ultrasound examinations were performed before and 24 h after medication administration. Visualization of a gestational sac and embryonic pole and presence or absence of cardiac activity were recorded. Sensitivity and specificity were calculated with the results from vaginal ultrasonography as the gold standard. The effect of body mass index (BMI) on ultrasound findings was also assessed. Results: Before treatment, the sensitivities of abdominal ultrasonography were 100% (95% CI 97-100) and 68% (95% CI 58-77) for presence of a gestational sac and an embryonic pole, respectively. Overall, abdominal imaging underestimated mean gestational age by 1.6 days (95% CI 1.0-2.2). After treatment, abdominal ultrasonography missed three of 34 retained gestational sacs (sensitivity 91%, 95% CI 76-98%). Fourteen women had gestational cardiac activity by vaginal ultrasound at follow-up. Abdominal imaging identified the gestational sac in all cases, but cardiac motion was only visible in 10 (71%, 95% CI 42-92%). For every 10-point increase in BMI, the odds ratio for missing an embryonic pole at baseline was 2.8 (95% CI 1.5-5.0). Conclusions: Abdominal ultrasonography is sensitive for diagnosing the presence or absence of a gestational sac, but less sensitive at detecting an embryonic pole. This may lead to a small underestimation of gestational age and missing a continuing pregnancy at follow-up when one exists.
Ultrasonographic Prediction of Early Miscarriages
Background: Spontaneous miscarriage is defined as an involuntary termination of pregnancy before 20th week of gestation or spontaneous expulsion of fetus below a fetal weight of 500 gm. Antenatal ultrasonography has been extremely useful in providing better understanding the etiology of first trimester spontaneous abortion and a basis for its clinical classification and management The aims and objective of this study is to identify abnormal ultrasound parameters and correlate the ultrasonic findings with the clinical outcomes. Materials and Methods: The study included 100 pregnant women attending outpatient department or also admitted in inpatient at 5-12 weeks of gestation fulfilling inclusion and exclusion criteria. Results: The abortion rate in our study was 34%. Out of that 18% abortion occurred at< 8 weeks and 16% occurred at 8-12 weeks of gestation. In this study, 30 patients had threatened abortion out of which 23(76 %) had abnormal TVS parameters. In our study 44 patients had abnormal findings in TVS, of which 32 (72.7%) had EPF. Conclusion: This study emphasizes the role of ultrasound in prediction of early pregnancy failure in first trimester. It can also help in taking decision whether to continue, abort or follow conservative management in early pregnancy.
Asian Journal of Medical Sciences, 2022
Background: Uterine bleeding in early pregnancy represents a definite threat to developing embryo and is directly proportional to the amount of bleeding. It is associated with an increased risk of poor obstetric and neonatal outcomes such as preterm labor, low birth weight, and premature rupture of membranes (PROM). Aims and Objectives: This study aims to investigate the effect of the first trimester vaginal bleeding on maternal and perinatal outcomes. Materials and Methods: This prospective observational study carried out in a tertiary teaching hospital of Kolkata, between January 2019 and June 2020. Here,190 patients with the first trimester vaginal bleeding were included in the study. Outcome of pregnancy was assessed in the form of obstetrical complications such as placenta previa, PROM, preterm labor, intrauterine fetal death, intrauterine growth retardation (IUGR), and neonatal outcomes such as prematurity, low birth weight, low appearance, pulse, grimace, activity, and respir...