A cross-sectional study comprising 117 consecutive first trimester singleton pregnancies was performed using transvaginal sonography (TVS) to evaluate size abnormalities of the secondary yolk sac (YS) vis-a-vis pregnancy outcome. In normal pregnancy outcome (NPO) the YS diameter showed an increase from the 5th to the 11th week, menstrual age, followed by a decrease and its disappearance after 12 weeks, A YS of abnormal size was statistically significant ( p < 0.001) in spontaneous abortion (SA) versus NPO, with a sensitivity of 68.7%, a specificity of 99%, a positive predictive value of 91.6% and a negative predictive value of 95.2%. These The secondary yolk sac (YS) is the first extraembryonic structure that can be detected with transvaginal sonography (TVS) in the chorionic cavity and can be seen from the 5th to the 12th week, menstrual age (MA), at the latest. At the beginning it appears as a spherical, translucent structure connected to the embryo by a stalk, the vitelline, or the omphalomesenteric duct.Spontaneous abortion (SA) is a common complication of pregnancy in about 15% of recognizable pregnancies,' although recent studies indicate that its incidence might be higher. More than 60% of products of conception are lost early in the first trimester of pregnancy.2New diagnostic tools that improve the ability to diagnose early complications of pregnancy may be considered as a significant clinical achievement, reassuring both the physician and the patient. TVS has made it possible to discriminate between viable and nonviable pregnancies earlier than transabdominal sonography (TAS with this diagnosis. Also fetal bradycardia7-' and the evidence of a small gestational sacg may indicate poor fetal viability. Many studies on the prognostic significance of the YS for pregnancy outcome have been performed with conventional sonography and more recently with TVS. The results are still conflicting as regards the prognostic significance of either the a b~e n c e~, '~-~~ or abnormalities in size and ~h a p e~~, '~-' ' of the YS as potential predictors of poor pregnancy outcome. Furthermore, these studies differ from each other in their design and in the sample of population examined. Some authors do not mention the absence of clinical symptoms of pregnancy failure (ie, vaginal bleeding, pelvic pain)6,'2,14,'8; others include pregnancies with symptoms of threatened a b~r t i o n . "~'~~~~The aim of our cross-sectional study was (1) to use TVS to study the biometry of YS and its variability in early pregnancy, and (2) in asymptomatic first trimester pregnancy, t o determine whether the size abnormalities of the YS were associated with pregnancy failure in order to clarify the clinical role of YS in first trimester pathol-0 0 . MATERIALS AND METHODS
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