G. Papaioannou

Ultrasonographic prediction of early miscarriage

BACKGROUND The aim of this retrospective study was to assess the value of maternal history and ultrasound scan findings at 6-10 weeks for predicting early miscarriage. METHODS Embryonic crown-rump length (CRL), heart rate (HR), gestational sac diameter (GSD) and yolk sac diameter (YSD) were compared in two groups of women with singleton pregnancies attending an early pregnancy unit. In the first group the initial scan demonstrated a live embryo but in a subsequent visit the scan showed a dead embryo, complete or incomplete miscarriage. In the second group with a live embryo there was subsequent live birth of a normal neonate. RESULTS There were 729 pregnancies with miscarriage and 4698 with normal outcome. Logistic regression analysis demonstrated that in the prediction of miscarriage the risk was higher in women of African racial origin [odds ratio (OR) 1.62], cigarette smokers (OR 1.91) and those with vaginal bleeding (OR 2.03) and increased with maternal age (OR 1.05) and YSD (OR 1.88) and was inversely related to CRL (OR 0.79), HR (OR 0.96) and GSD (OR 0.84). At false-positive rate of 30%, the detection rate of miscarriage in screening by vaginal bleeding was 45%, 53% by the addition of maternal history factors and 85.7% by the addition of ultrasound findings. CONCLUSIONS In early pregnancy a prediction of miscarriage can be provided by a combination of maternal characteristics and ultrasound findings and the estimated risk can be used to rationalize follow-up. Our multivariate model requires prospective evaluation in a new sample population.

Normal ranges of embryonic length, embryonic heart rate, gestational sac diameter and yolk sac diameter at 6-10 weeks.

Objectives: To construct normal ranges for embryonic crown-rump length (CRL), heart rate (HR), gestational sac diameter (GSD) and yolk sac diameter (YSD) at 6–10 weeks of gestation. Methods: We examined 4,698 singleton pregnancies with ultrasound measurements of CRL, HR, GSD and YSD at 6–10 weeks and CRL at 11–13 weeks resulting in the live birth after 36 weeks of phenotypically normal neonates with birth weight above the 5th centile. Gestational age was derived from CRL at the 11- to 13-week scan using the formula of Robinson and Fleming. Regression analysis was used to establish normal ranges of CRL, fetal HR, GSD and YSD with gestation, and fetal HR, GSD and YSD with CRL. Results: At 6–10 weeks there were significant quadratic associations between CRL, GSD, YSD and gestation and between HR, GSD, YSD and CRL, and a cubic association between HR and gestation. The estimated gestation from CRL was the same as that of Robinson and Fleming for a CRL of 10.2–36.5 mm, but the formula of Robinson and Fleming underestimated the gestation by 1 day for a CRL 7.4–10.2 mm and this increased to 9 days for a CRL of 1 mm. Conclusion: This study established normal ranges for early pregnancy biometry.

ASPRE trial: performance of screening for preterm pre-eclampsia

To examine the performance of screening for preterm and term pre‐eclampsia (PE) in the study population participating in the ASPRE (Combined Multimarker Screening and Randomized Patient Treatment with Aspirin for Evidence‐Based Preeclampsia Prevention) trial.

ASPRE trial: incidence of preterm pre‐eclampsia in patients fulfilling ACOG and NICE criteria according to risk by FMF algorithm

To report the incidence of preterm pre‐eclampsia (PE) in women who are screen positive according to the criteria of the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG), and compare the incidence with that in those who are screen positive or screen negative by The Fetal Medicine Foundation (FMF) algorithm.

Prediction and prevention of small-for-gestational-age neonates: evidence from SPREE and ASPRE

To examine the effect of first‐trimester screening for pre‐eclampsia (PE) on the prediction of delivering a small‐for‐gestational‐age (SGA) neonate and the effect of prophylactic use of aspirin on the prevention of SGA.

OC01.04: Aspirin versus placebo in pregnancies at high‐risk of preterm pre‐eclampsia: a multicentre, double‐blind, placebo‐controlled trial

The Kruskal-Wallis one-way analysis of variance on ranks showed that the imaging techniques had different precision in estimating the degree of bowel stenosis (p<0.001). The Tukey test showed that CTC was more precise than other techniques in estimating the degree of bowel stenosis (p<0.05); MRI-e was more precise than TVS (p<0.05). Conclusions: CTC is more precise than TVS, RWC-TVS and MRI-e in estimating the degree of stenosis of the bowel lumen in patients with colorectal endometriosis.

Yolk Sac Diameter in Early Pregnancy in Maternal Diabetes Mellitus

Aims: To investigate the possible association between maternal diabetes mellitus and increased yolk sac diameter (YSD). Methods: We searched the Early Pregnancy Unit database to identify singleton pregnancies with measurements of embryonic crown-rump length (CRL) and YSD at 6–10 weeks of gestation and subsequent delivery of phenotypically normal neonates. We compared the YSD in patients with pre-gestational and gestational diabetes with those who were unaffected by diabetes. Results: A total of 3,686 cases were identified including 43 (1.2%) with type 1 diabetes, 31 (0.8%) with type 2 diabetes and 71 (1.9%) who subsequently developed gestational diabetes. The measured YSD in both the diabetic and non-diabetic groups were expressed as differences from the expected normal mean for CRL (Δ values). There were no significant differences in ΔYSD between the groups. The median (IQR) ΔYSD was 0.01 (–0.33 to 0.37) mm in the unaffected group, 0.01 (–0.35 to 0.51) mm in type 1 diabetes, –0.02 (–3.44 to 0.27) mm in type 2 diabetes and 0.01 (–0.28 to 0.35) mm in gestational diabetes. Conclusion: After exclusion of miscarriages and embryopathies, pre-gestational and gestational diabetes are not associated with altered YSD.