J. Elson

Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening.

OBJECTIVE To determine reproductive outcomes in women with congenital uterine anomalies detected incidentally by three‐dimensional ultrasound. METHODS We studied 1089 women with no history of infertility or recurrent miscarriage who were seen for a transvaginal ultrasound scan. They were screened for uterine abnormalities using three‐dimensional ultrasound. We determined prevalence of miscarriage and preterm labor in women with normal and abnormal uterine morphology. RESULTS We found that 983 women had a normally shaped uterine cavity, 72 an arcuate, 29 a subseptate, and five a bicornuate uterus. Women with a subseptate uterus had a significantly higher proportion of first‐trimester loss (Z = 4.68, P < .01) compared with women with a normal uterus. Women with an arcuate uterus had a significantly greater proportion of second‐trimester loss (Z = 5.76, P < .01) and preterm labor (Z = 4.1, P < .01). There were no other significant differences in pregnancy outcomes between women with normal and abnormal uterine morphology. CONCLUSION This study shows the potential value of three‐dimensional ultrasound and confirmed that women with congenital uterine anomalies were more likely to have adverse pregnancy outcomes than women with a normal uterus.

Expectant management of early pregnancies of unknown location: a prospective evaluation of methods to predict spontaneous resolution of pregnancy

Objective To assess prospectively the ability of two multiparameter diagnostic models and their individual components to predict the outcome of early pregnancies which could not be identified on transvaginal ultrasound scan.

Expectant management of tubal ectopic pregnancy: prediction of successful outcome using decision tree analysis

To establish whether a decision tree based on a combination of clinical, morphological and biochemical parameters could be constructed to help in the selection of women with tubal ectopic pregnancies for expectant management.

Prediction of early pregnancy viability in the absence of an ultrasonically detectable embryo

To identify clinical, ultrasound and biochemical parameters that may allow prediction of pregnancy viability in women without a detectable embryo on ultrasound examination.

Factors influencing the success of conservative treatment of interstitial pregnancy.

To identify demographic, morphological and biochemical characteristics of interstitial pregnancies that are associated with a successful outcome of conservative treatment (expectant management or medical treatment with methotrexate).

OC019: The efficacy of ultrasound‐based protocol for the diagnosis of tubal ectopic pregnancy

Background: Ultrasonography is highly reliable in the management of women with early pregnancy complications. An endometrial cut-off < 15 mm with no retained products of conception has been used to classify complete miscarriage (CM) on transvaginal sonography (TVS). However despite a history of heavy vaginal bleeding, a proportion of these women have an undiagnosed ectopic pregnancy (EP). We evaluated the need for hormonal follow up in women with a history and scan findings suggestive of CM. Materials and methods: Prospective observational study. 5918 consecutive women presented to the Early Pregnancy Unit − 223 (3.8%) were classified CM on the basis of a history of heavy vaginal bleeding and the above sonographic criteria. 56 were not pregnant and 24 were lost to follow up. 143 were included in the analysis. Serum human chorionic gonadotrophin (hCG) levels were taken at presentation and 48 hours later. All women were followed up until hCG < 5 U/L or a cyesis was visualised on TVS. Results: 131/143 (91.6%) CM confirmed according to hCG follow up. 8/143 (5.6%) confirmed to be EP requiring further treatment. 2/143 (1.4%) persisting pregnancies of unknown location (PUL) requiring methotrexate therapy. 2/143 (1.4%) intrauterine pregnancies – one blighted ovum and one ongoing IUP. If hCG levels rose, 10/12 (83%) required intervention. Conclusions: Diagnosis of complete miscarriage based on history and scan findings alone is unreliable, as up to 6% will have an ectopic pregnancy. If hCG levels do not fall, these women should be followed closely until the location of the pregnancy is confirmed.

Biochemistry in diagnosis and management of abnormal early pregnancy.

Purpose of review This review examines the biochemical parameters of early pregnancy failure and the role that biochemical markers have to play in the selection of patients for expectant management. Recent findings Earlier studies have concentrated on the role that human chorionic gonadotrophin and progesterone have to play in early pregnancy failure. Recent studies, however, have explored newer markers such as the inhibins and insulin growth factor binding proteins. Diagnostic models have now been created incorporating demographic, morphological, and biochemical parameters for the prediction of successful expectant management of early pregnancy failure. Summary Examining the role of newer biochemical markers in early pregnancy failure has led to an improved understanding of the mechanisms behind it. Incorporation of these newer markers into diagnostic models has aided selection of patients for whom expectant management is appropriate.

OC196: The value of serum biochemistry in the expectant management of incomplete miscarriage

16/37 (43%) had a normal scan with mobile ovaries and no pelvic tenderness. 8/37 (22%) patients had a normal scan with no abnormality but tenderness. 5/37 (14%) had an ovarian cyst rupture. 8/37 had a normal scan with a non-gynaecological diagnosis. 27/37 (73%) of patients returned the follow up questionnaire. 22/35 (63%) of the patients had satisfactory resolution of their symptoms. Conclusion: The majority of patients attending an acute gynaecology unit with acute pelvic pain will have no gross pathology. In the majority of patients the symptoms will resolve satisfactorily within 7 days.

OP15.03: The prediction of outcome of expectant management of ectopic pregnancies

Methods: We recruited 282 cases of which ultrasonographic examination were done by ten 2nd year residents. EFW by ultrasonography was measured within 48 hours prior to delivery and actual birth weight (BW) was collected. We calculated percentage error that means the difference between ultrasonographic EFW and actual BW divided by actual BW and multiplied by 100. We also obtained the values at upper and lower 25% deviation from median. The range between 25% and 75% quartiles was obtained for each resident. The Pearson correlation was used for statistical analyses. Results: The correlation coefficient between the ultrasonographic EFW and actual BW was 0.907 (P < 0.001). EFW less than 10% of difference was in 74.8% of cases. Ultrasongraphic performance varied according to each resident. The narrowest range between 25% and 75% quartiles was 8.6% and the widest range was 15.7%. Two residents showed median values of higher than 2 percent error and one showed median values of lower than −2 percent error. Conclusions: Although ultrasonographic EFW performed by residents is correlated with the actual BW, the accuracy of EFW is affected by personal skill even in the same grade of residency. We suggest that percentage errors can be used as an evaluation and tuition tool to improve ultrasonographic performance of measuring fetal weight.

OC020: Prospective evaluation of a logistic model for the prediction of early pregnancy viability

of gestation with successful vaginal delivery. The same parameters were measured in every two hours until rupture of the membrane. Results: In all but nine women during the first 2 hours the median cervical length 23.6 (10–40) mm changed into 45%, during the 3–4th hours into 35%, and in the 5–6th hours into 26% of the original length. The cervical width became less reliable, for this reason this parameter was not taken into consideration. The median funneling length increased almost 1.8 fold during the first 2 hours, 2.1 fold in the 3–4th hours and 2.4 fold in the 5–6th hours. The median funneling width showed a 1.3 fold increase during the first two hours, a 1.5 fold increase during the 3–4th hours and 1.9 fold increase in the 5–6th hours. In seven cases we did not observe any changes in these parameters during 6–10 hours after the prostaglandin instillation and the instillation finally had to be repeated. Conclusions: Transvaginal sonography seems to be a useful tool in monitoring of cervical changes during artificial induction of labor by prostaglandins. According to our data cervical shortening and funneling proved to be the most important signs of the success of cervical ripening. The need for repeated prostaglandin instillation could be evaluated with objectivity by ultrasonography.