K. Sankaralingam

Is there a correlation between birth weights and first-trimester crown-rump length growth velocity?

Objective: To test the hypothesis that small- or large-for-gestational-age (SGA or LGA) newborns have anomalous crown-rump length (CRL) growth rates in the first trimester. Methods: Prospective observational study. Women in the first trimester presenting to the Early Pregnancy Unit, between November 2006 and December 2010, underwent transvaginal scan. Women with viable singleton pregnancies in the first trimester who had at least two CRL measurements > 5 mm, recorded at least 2 weeks apart, and also had birth weight data available were included in the final analysis. Birth weight percentiles were calculated and adjusted for gestational age and gender. SGA was equivalent to < 10th centile and LGA was equivalent to > 90th centile. Correlation analysis was performed between birthweight percentiles and first-trimester CRL growth-rate coefficients. In addition, we estimated early fetal growth rates (EFGR) by calculating the Δ CRL/Δ time (mm/day) to see if these differed according to the birth-weight percentiles. Results: A total of 107 women had complete data. The mean maternal characteristics were age 27.5 ± 6 years, weight 87 ± 29 kg and height 163 ± 8 cm. The mean birth weight and gestational age at delivery were 3405 g (SD = 597) and 269 days (SD = 13), respectively. The proportions of SGA and LGA were 7.5% and 18.7%, respectively. There were no significant correlations between birth-weight percentiles and any of the CRL growth rates. There were also no significant differences in the mean CRL velocities when comparing the SGA and LGA newborns birth weights. EFGR for SGA and LGA newborns were 1.34 mm/day (SD = 0.17) and 1.32 mm/day (SD = 0.24), respectively (p > 0.05). Conclusions: Newborns who are found to be SGA or LGA at delivery do not appear to have anomalous CRL growth patterns in the first trimester. The EFGR also did not correlate with birth-weight percentiles.

Is there a correlation between aberrant embryonic crown-rump length growth velocities and subsequent birth weights?

In this study, we tested the hypothesis that anomalous first trimester growth affects birth weight. Four hundred and fifteen women with viable singleton pregnancies at the primary transvaginal scan who had at least two crown rump length (CRL) and birth weight data were included. A linear mixed model was fitted to the Box-Cox transformed CRL values to evaluate the association between the GA and the embryonic growth. For multivariate analysis we included maternal age, height, weight, parity, number of miscarriages, vaginal bleeding, smoking, foetal gender, birth weight, small-for-gestation (SGA) and large-for gestation (LGA) categories at delivery. Smoking appeared to be significant for predicting the initial CRL from the beginning of the pregnancy (p value = 0.013). The SGA foetuses appeared to have slightly slower embryonic growth rates compared to non-SGA (p value = 0.045), after taking into account the effect of smoking on the initial CRL. None of the other variables including subsequent birth weight or LGA category have statistically significant effect on the first trimester embryonic growth curve when tested separately.

P05.04: Is the embryonic growth rate in the first trimester influenced by cigarette smoking?

respectively. There was no major complication, however, 4 cases required intensive therapy unit care and blood transfusion, with total blood loss over 3 litres. Two of these cases had successful laparoscopic management. Average hospital stay was 2 days. Conclusions: Our study showed that 6% non-tubal ectopic pregnancies accounted for all ectopic pregnancies in the unit. Experience at ultrasound diagnosis and laparoscopic technique can lead to earlier diagnosis and few operative failures needing laparotomy. In spite of potential morbidity, laparoscopic surgery should be considered for women requiring surgery where laparoscopic expertise available. Medical management should be considered where appropriate.

P04.05: Gestational sac volume is inversely related to maternal height

into an EP were included in the final analysis. The clinicians were blinded to the initial hCG ratio when the diagnosis of EP was made. Women were managed expectantly, medically or surgically based on local protocols. Using the ANOVA test, correlation between initial hCG ratio and the type of subsequent management was analysed. Results: Of the 3341 consecutive scans were performed at the EPU during the study period, 5.8% (194/3341) were diagnosed with an EP. Within this group, 74.7% (145/194) of the EPs were seen at the first scan and 25.3% (49/194) of the EPs started as PULs. In the group of EPs that started as PULs, hCG ratios were available on 95.9% (47/49) women. The mean hCG ratio at the time of PUL classification for those EPs subsequently managed expectantly, medically and surgically was 1.1, 1.1 and 1.3 respectively (P = 0.06). Conclusions: The hCG ratio of those EPs that commence as PULs does not appear to correlate with the EP management.

P05.01: Effects of cigarette smoking on first trimester sonographic markers in women with certain menstrual dates

given intramuscularly in a dose of 50 mg per square meter of bodysurface area. Clinical observation, ultrasound examination were performed and serum chorionic gonadotropin was measured until the level was less than 15 IU/L. The patient required multiple-dose protocol. Time to resolution was 21 days. Conclusion. Small size of ectopic pregnancy after ART and a chance of its atypical localization may often complicate laparoscopic treatment of this condition and, therefore, emphasize the value of ultrasound diagnosis and medical management option.

P16.18: Is there a correlation between crown‐rump length at the nuchal translucency screen and subsequent birth weights or prematurity?

actual state of the developing early pregnancy can be estimated using the last menstrual period, the measurement of embryonic heart rate and crown rump length, establishing growth curves, sonographic determination of the structure of the embryo-placental compartment. The purpose of this study was to examine the value of embryonic heart rate in predicting the outcome in ongoing pregnancies. Methods: In a prospective observational study embryonic heart rate (EHR) and crown-rump length (CRL) were studied in very early pregnancies (n = 227) with normal and pathologic outcomes. The data were statistically evaluated (Systat SigmaPlot and SigmaStat). Results: Of the 227 very early pregnancies 17 had adverse outcome with clinical diagnosis of a missed abortion (n = 13), preterm delivery (n = 2), perinatal death (n = 2). 210 pregnancies had normal outcome. Of the 13 pregnancies with missed abortion 10 cases were out of 5th and 95th percentiles’ of the normal value curves. 69% of pregnancies with missed abortion were out of the normal ranges of the embryonic heart rate. Conclusions: The measurement and determination embryonic heart rate corresponding to the actual crown rump length is an efficient method for early prediction of adverse pregnancy outcome especially in missed abortion cases. The predictive value of EHR was most efficient in nulliparous gestations at a crown rump length between 1.6–12.0 mm.

P16.02: The effect of cigarette smoking during the first trimester and subsequent birth weight at delivery: a longitudinal study

Results: The shapes of the NPA of the targeted myoma were divided into 4 types: Type 1: No or little perfused area. Type 2: Perfused area near the posterior margin. Type 3: Perfused area near both anterior and posterior margins, or all around the margin. Type 4: Perfused area within the myoma including the area in type 3. The mean NPA of types 1, 2, 3 and 4 was 76.9 ± 12.3%, 57.3 ± 8.8%, 51.0 ± 10.2%, and 38.3 ± 16.7%, respectively (P < 0.01). The relation between the phases of the menstrual cycle and the shape of the NPA, or the rate of the TA, was not statistically significant. Conclusions: The menstrual cycle does not significantly affect the type of NPA or the rate of the TA of MRgFUS-treated uterine myoma, suggesting that the treatment of myoma with MRgFUS is not circumscribed by the menstrual cycle.

P05.08: Viable intrauterine pregnancies: what influences outcome of the first trimester?

Objectives: To establish if there is a difference between left and right sided ectopic pregnancy rates and if anatomical position has any relationship to clinical presentation. Previous studies have concluded with either support for Berlind’s theory of ovum transmigration or no proven difference between left or right ovulation and the risk of ectopic pregnancy (1, 2). Methods: Analysis of computerised databases in a tertiary referral centre, from 2002–2013 retrospectively compared the anatomical site of ectopic pregnancy and corpus luteum on transvaginal scanning as well as associated clinical symptoms. Results: We found a right-sided tubal pregnancy in 58.5% (282/482) cases (95% CI 54–62%, P < 0.002). Recurrence of ectopic pregnancy was also more likely to be right-sided 60% (15/25, 95% CI 52–89%, P < 0.02). A classical presentation of pain and bleeding was consistent in 47% (134/282) of right tubal pregnancy or 28% (134/482) of total cases. Left tubal pregnancy had a variable presentation of either no symptoms [35% (70/200)], pain [23.5% (47/200)], bleeding [13%(26/200)] or pain and bleeding (28.5% (57/200)]. In cases where the side of the corpus luteum was recorded, 54% (187/346) were on the ipsilateral side to the ectopic pregnancy, 59% (112/190) for right (95% CI 51–65, P < 0.05) and 48% (75/156) left ectopic pregnancies (95% CI 40–55%). Conclusions: Right-sided ipsilateral tubal pregnancy following rightsided ovulation is more common than left. Left sided tubal pregnancy presented less commonly with classical symptoms and evidence of ipsilateral ovulation and this is being further investigated prospectively.

OP05.05: The crown‐rump to yolk sac ratio is inversely correlated with birth weight percentiles

(22/41) women were discharged after the initial visit. No women in this group required repeat TVS, one woman required a repeat hCG for worsening pelvic pain. PUL outcome (i.e. failed PUL) was confirmed on Day 2 for all women; (2) 9.76% (4/41) women required repeat serum hCG levels and 50% (2/4) required repeat TVS. 75% (3/4) had a failed PUL, one woman had a persistent PUL requiring methotrexate. PUL outcome was confirmed between Days 6–16; (3) 36.6% (15/41) with hCG ratio ≥ 1. Repeat TVS confirmed 66.7% (10/15) women with intrauterine pregnancy, 33.3% (5/15) with ectopic pregnancy. PUL outcome was established between Days 2–16. Including all women in this study, PUL outcome was established for 56.1% (23/41) at Day 2, 12.2% (5/41) between Days 3–6, 22% (9/41) at Day 7–14, and 9.76% (4/41) at > Day 14. Conclusions: A new protocol based on predetermined hCG ratio cut-offs for women with a PUL enables a safe, consistent approach that may also have the potential to minimize the need for repeat bloods and scans in women with a PUL.

OP02.10: First trimester ultrasonographic markers, birth weight and gestational age at delivery

Results: 154 women were initially diagnosed with PUL. Excluding 11 cases lost to follow up 143 were included in the final analysis. 23.1% (33/143) were intrauterine pregnancies of uncertain viability IPUV) at follow up, 69.2% (99/143) were failing PULs and 7.7% (11/143) were EP. 136 records with complete data were used to develop the model. hCG ratio had the strongest correlation with PUL outcome. hCG at 48 hours and its logarithmic transformation was also significantly different among different PUL outcome groups. A decision tree was built using J48 in R package Rweka. A model utilising these variables, gives a classification accuracy of 92.6%. 5/136 were misclassified: 2 EP and 3 IUP as failing PULs. Conclusions: A decision tree model using EV, GSI, FI, VI, VFI and hCG gave an accurate classification rate of 96.3%. EV, GSI, FI, VI, VFI alone gave an accurate classification rate of 84.6%. hCG at 0 h & hCG ratio alone gave an accuracy of 91.2%.