Objectives To examine whether viable early pregnancies that subsequently end in miscarriage exhibit evidence of first-trimester growth restriction.Design Prospective cohort study.Setting Early pregnancy unit (EPU) of a teaching hospital.Population Women attending EPU between 5 and 10 weeks of gestation.Methods Women with spontaneously conceived intrauterine, viable singleton pregnancies with certain last menstrual period and regular cycles were included. The deviation between the observed and expected crown-rump length (CRL) for gestation was calculated and expressed as a z score. Pregnancies were followed up until the 11-14 week scan, and the deviation between those that remained viable and miscarried subsequently was calculated.Main outcome measures Viability at 11-14 week scan.Results Over 6 months, 316 women met the inclusion criteria. Twenty-four (7.4%) women were excluded. Of the remaining 292, the pregnancy remained viable in 251 (86%) and 41 (14%) suffered a miscarriage. At the first transvaginal ultrasound, the z score of the mean measured CRL for pregnancies that remained viable was -0.82, SD 1.46, while in pregnancies that subsequently miscarried the z score was -2.42 and the CRL was significantly smaller, SD 1.31 (P < 0.0001). In the latter group, the initial CRL was below the expected mean for gestational age in all women, while in 61% (25/41), the CRL was at least 2 SDs below the expected mean.Conclusions CRL was significantly smaller in pregnancies that subsequently ended in miscarriage. This suggests that early firsttrimester growth restriction is associated with subsequent intrauterine death.
The ability to confirm viability or non-viability is significantly related to gestational age. In asymptomatic women with no previous ectopic pregnancy TVS should be delayed until 49 days. Our data suggest that this would reduce the number of inconclusive scans, without an associated increase in morbidity from missed ectopic pregnancies.
Rate of increase in CRL was greater in fetuses of black versus white women and increased with advancing maternal age. As CRL is used to date pregnancies, and this influences further growth assessment, consideration should be given to the use of individualized growth charts which take account of maternal factors found to influence first trimester growth.
Objectives To define the incidence and outcome of intrauterine pregnancy of uncertain viability (PUV) and to develop and assess the performance of a model and a scoring system to predict ongoing viability. 0.837 (95% CI, in the training dataset and 0.821 (95% CI, in the test dataset. viability was predicted by the model with an AUC of 0.788 (95% CI, in the training dataset and 0.774 (95% CI,
Methods
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