The conservative management of first trimester miscarriages and the use of colour Doppler sonography for patient selection (original) (raw)
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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.
2015
Objective: The aim of this study was to identify the role of transvaginal color Doppler and grayscale ultrasonography findings in managing first-and second-trimester miscarriges. Methods: A prospective interventional study was conducted from March 2009 to April 2010 in our center in which 77 women with first-and second-trimester abortion were recruited. All women were evaluated by transvaginal grayscale and color Doppler ultrasonography. Blood flow within the endometrium was measured using color Doppler. Pulsed Doppler was performed to evaluate blood flow impedance by calculating the resistance index (RI). Results: Forty-six patients underwent dilation and curettage of which 67.4% were proven to have retained products of conception (RPOC). Thirty-one patients were followed up through expectant management. Endometrial thickness (ET) was greater in the group with RPOC (p < 0.001). The sensitivity, specificity, and positive and negative predictive values with 95% confidence intervals of vascularity for detecting RPOC were 88% (72e97%), 68% (52e81%), 67% (51e81%), and 88% (73e97%), respectively. RI was significantly lower (p Z 0.004) among these patients. Echogenic mass was detected in 93.9% of women with RPOC, but only in 22.7% of the cases without retained tissues (p < 0.001). Transvaginal grayscale ultrasonography was 100% sensitive in detecting RPOC when ET was >10 mm. The combination of vascular pattern and endometrial echogenic mass was the most sensitive and specific ultrasonographic feature for detecting RPOC (88%; 95% confidence intervals: 79e95). Journal of Medical Ultrasound (2015) 23, 34e38 Conclusion: Transvaginal color Doppler ultrasonography can be used to verify the presence of RPOC after spontaneous miscarriges. ª
Human Reproduction, 2012
To evaluate whether the use of power Doppler to confirm the presence or absence of blood flow within retained products of conception (RPC) in women with an incomplete miscarriage can predict subsequent successful expectant management. methods: Prospective observational study in the Acute Gynaecology and Early Pregnancy Unit (AGEPU) at Nepean Hospital from November 2006 to February 2009. Incomplete miscarriage was defined by the presence of a measurable focus of hyperechoeic material, in three planes, within the endometrial cavity using two-dimensional greyscale transvaginal ultrasound (TVS). Subjective qualitative power Doppler colour scoring (PDCS) of the RPC was performed. The vascularization of the RPC was scored using the colour scoring system of the International Ovarian Tumour Analysis (IOTA) group. PDCS 1 meant absence of vascularity, PCDS 2 represented minimal vascularity, PDCS 3 rather strong vascularity and PDCS 4 very strong vascularity. The correlation between the PDCS and successful expectant management of miscarriage was analysed. The volume of RPC was calculated using the ellipsoid formula and then compared with both the PDCS and the outcome of expectant management. Successful expectant management was defined as the resolution of symptoms and the absence of RPC on follow-up TVS. results: A total of 1395 consecutive pregnant women underwent TVS. Of them, 198 women were diagnosed with an incomplete miscarriage; 172 were managed expectantly. Complete data were available on 158 cases. In total 84.8% (134/158) were managed successfully whilst 15.2% (24/158) failed expectant management. Of the total, 89% (121/136) of women with a PDCS 1 had successful expectant management compared with 57.1 (8/14) with PDCS 2 and 62.5% (5/8) with PDCS 3. Comparing absence of flow (PDCS 1) to presence of flow (PDCS 2 or more), the rate of success was significantly higher in the first group (89 versus 60.9%, Fisher's exact test P ¼ 0.00136). In the prediction of success, the absence of flow showed a sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio of 90.3, 37.5, 89, 40.9% and 1.445 (95% confidence interval: 1.055-1.979), respectively. There was no correlation between the volume of RPC and the PDCS; and there was no relationship between the volume of RPC and the success of expectant management. conclusions: PDCS can predict the likelihood of successful expectant management of incomplete miscarriage. The absence of flow on power Doppler is associated with a significant improvement in the rate of successful expectant management. This new approach may be helpful in quantifying the chances of successful expectant management in those women with an incomplete miscarriage at the primary scan.
Medical and Surgical Treatment of First Trimester Miscarriage, A Randomized Controlled Trial
The Egyptian Journal of Hospital Medicine, 2021
Background: Abortion is a common complication of early pregnancy that can have both medical and psychological consequences. Complications following spontaneous or induced abortion are a major cause of maternal morbidity. Objective: To better management and improving outcome of first trimestric miscarriage. Patients and Methods: A randomized clinical trial study was conducted at obstetric outpatient clinic, Gynecology and Obstetrics Department, Zagazig University during the period from May 2019 until June 2021. The study included 52 women suffering from abortion who were randomized to receive either medical treatment: 800 µg misoprostol prescribed as 400 mg orally and 400 mg vaginally or surgical treatment: evacuation with dilatation and curettage. All patients were followed up with a transvaginal ultrasonography (U/S). Results: The mean of endometrial thickness after treatment was 12.5±2.65 mm and 8.3±1.97 mm in misoprostol and surgical evacuation group respectively, the difference ...
The role of ultrasound imaging in diagnosing and investigating early pregnancy failure
Ultrasound in Obstetrics and Gynecology, 2005
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 firsttrimester 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 firsttrimester 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.
Journal of Ultrasound in Medicine, 2020
Objectives-(1) To study the predictors of pregnancy continuation up to 28 weeks in first-trimester threatened miscarriage after a single clinical and ultrasound (US) evaluation. (2) To assess the role of both clinical and US predictors in counseling and decreasing repeated emergency follow-up scans. Methods-A prospective observational study that included a cohort of 241 patients with threatened miscarriage (≥6-12 weeks) was conducted. They had a single clinical and US evaluation, and then they were contacted by weekly phone calls until completing 28 weeks' gestation or reporting miscarriage. Independently, all patients were followed by the recommended routine US scanning with or without emergency visits. Results-Two hundred thirty-three patients completed the study, of whom 193 patients continued up to 28 weeks' gestation, and 40 miscarried (17.1%). Only spotting/mild bleeding episodes and progesterone treatment were the clinical predictors of fetal viability. The embryonic/fetal heart rate (E/FHR) was the best single US predictor, with a specificity and positive predictive value of 95.3% and 97.2%, respectively. Combining 3 US parameters, at their best cutoff points (E/FHR >113 beats per minute, crown-rump length >13.9 mm, and gestational sac diameter >27.3 mm), had a specificity and positive predictive value of 98% and 99% (first-trimester US triad of fetal viability). Conclusions-[1] In first-trimester threatened miscarriage, clinical parameters that could predict fetal viability included shortspotting/ mild bleeding and progesterone treatment. [2] After a single US scan, the presence of at least an E/FHR of greater than 113 bpm or the suggested first-trimester US triad appeared as a simple, measurable, and effective predictor of pregnancy continuation up to 28 weeks. [3] These US predictors are not to replace the recommended scheduled scanning during pregnancy. [4] This can improve patients' counseling and decrease the need for repeated emergency follow-up scans. Otherwise, there is an indication for repeating US scans at a 1-week to 10-day interval.
Obstetric outcome in women with threatened miscarriage in the first trimester
Obstetrics and gynecology, 2006
To assess pregnancy outcomes in women with threatened miscarriage in the first trimester. This was a retrospective cohort study based on data extracted from the Aberdeen Maternity and Neonatal Databank. Cases included all primigravid women with first-trimester vaginal bleeding who delivered after 24 weeks of gestation between 1976 and 2004. The control group comprised all other women who had first pregnancies during the same period. Data were analyzed by univariate and multivariate statistical methods. Compared with the control group (n = 31,633), women with threatened miscarriage (n = 7,627) were more likely to have antepartum hemorrhage of unknown origin (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.73-2.01). Elective cesarean (OR 1.30, 95% CI 1.14-1.48) and manual removal of placenta (OR 1.40, 95% CI 1.21-1.62) were performed more frequently in these women, who also had a higher risk of preterm delivery (OR 1.56, 95% CI 1.43-1.71) and malpresentation (OR 1.26, 95% CI 1.13...
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.
Romanian Journal of Medical Practice
Introduction. Uterine abnormalities are traditionally presented as the cause of pregnancy loss at specific time of pregnancy, mostly at the first or second trimester. The aim of the current study is to use ultrasound to identify the relationship between the incidence of uterine abnormalities and miscarriage at different stages of pregnancy. Patient and method. 174 cases of women with miscarriage have been examined by transabdominal and transvaginal ultrasound. The patient age was from (18 to 45) years and the data collected over eight month from five different hospitals. Results. The age group of (26-35 years) has the largest percentage of miscarriage among other tested age groups with 40.8% in (71cases). Also it was found that single miscarriage was presented in most of the cases. Miscarriage in women with uterine abnormalities was found in 46.6% of the cases. The major uterine anomalies were bicornuate, septate, arcuate and unicornuate uterus which present in (24.69%, 19.75%, 9.88% and, 7.41%) respectively. Other ultrasound findings were fibroid, cervical incompetence and endometriosis which occur in (14.81%, 13, 58 % and, 9.88%) correspondingly. Conclusions. Pregnancy loss is likely to occur in women with bicornuate and septate uterus more than any other uterine anomalies, while the incidences are fewer in women with unicornuate uterus. Furthermore, uterine fibroid is present to be one of the major uterine diseases which can have negative impact on pregnant women, also cervical incompetence and endometriosis are considered as important factors, which can cause pregnancy loss that required further evidence.