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AIUM Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound. J Ultrasound Med 2024; 43:E20-32. [PMID: 38224490 DOI: 10.1002/jum.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
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Wojcicki J, Wawrysiuk S, Sochacki-Wojcicka N, Podlinska O, Pietrych L, Szpotanska-Sikorska M. More than a hundred thousand respondents within 48 h: How the power of social media helped to understand pregnancy loss in Poland - A retrospective population-based cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 289:29-35. [PMID: 37625286 DOI: 10.1016/j.ejogrb.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Miscarriage is defined as the loss of pregnancy before 20-24 weeks of gestation, and it is the most common complication of early pregnancy. The aim of the study was to determine the prevalence and risk factors of spontaneous abortion in the population of Polish females to provide a reference for clinical work. METHODS A cross-sectional self-administered on-line survey was distributed between 4th and 5th of October 2019 in the social media across Poland. A total of 100,026 recipients responded to the questionnaire and 93,636 valid respondents were included in the analyses. RESULTS Among respondents who had ever been pregnant, 31.2% reported at least one spontaneous abortion. The prevalence of miscarriage varied based on age, parity, place of residence and the education level. The first symptom of miscarriage was a vaginal bleeding (56.2%) and abdominal cramps (25.8%), while 43% of respondents had no symptoms and found out during doctor's visit. No medical assistance was required after complete spontaneous abortion in 39.2% of cases. CONCLUSIONS Miscarriage is a common complication of pregnancy, but it is not yet fully understood. The goal of future medicine is to minimize the medicalization of spontaneous abortion and excessive medical intervention by raising awareness about natural miscarriage route.
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Affiliation(s)
- Jakub Wojcicki
- Ernest Foundation - The Prenatal Medicine Foundation, Algierska 19W, 03-977 Warszawa, Poland
| | - Sara Wawrysiuk
- 2nd Department of Gynaecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland.
| | - Nicole Sochacki-Wojcicka
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. S. Starynkiewicza 1/3, 02-015 Warszawa, Poland
| | - Olga Podlinska
- Ernest Foundation - The Prenatal Medicine Foundation, Algierska 19W, 03-977 Warszawa, Poland
| | - Lukasz Pietrych
- Department of Econometrics and Statistics, Warsaw University of Life Sciences - SGGW, Nowoursynowska 166, 02-787 Warszawa, Poland
| | - Monika Szpotanska-Sikorska
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, pl. S. Starynkiewicza 1/3, 02-015 Warszawa, Poland
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Helle N, Niinimäki M, Linnakaari R, But A, Gissler M, Heikinheimo O, Mentula M. National register data are of value in studies on miscarriage-Validation of the healthcare register data in Finland. Acta Obstet Gynecol Scand 2022; 101:1245-1252. [PMID: 36056916 PMCID: PMC9812111 DOI: 10.1111/aogs.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/13/2022] [Accepted: 08/04/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Despite the high prevalence of miscarriages, they are not systematically registered and few epidemiological studies have been done. As Finnish health registries are comprehensive and widely used in research, we validated the Finnish register data concerning diagnostics and treatment of miscarriage, and treatment-related adverse events. MATERIAL AND METHODS We conducted a validation study regarding miscarriage-related codes of diagnoses and surgical procedures in a Finnish National Hospital Discharge Registry (NHDR) by comparing the information from the NHDR with that of the hospital records. We selected a random sample of 4 months during 1998-2016 from three hospitals, comprising 687 women aged 15-49 experiencing a first miscarriage during follow-up. Women with diagnoses unrelated to miscarriage, or proven to be other than miscarriage, were excluded. The final sample consisted of 643 women with confirmed miscarriage, which was used for analyses regarding the diagnosis, treatment and adverse events of miscarriage treatment. RESULTS The majority of miscarriages registered in the NHDR were confirmed by the hospital records (positive predictive value [PPV] = 93.6% [95% confidence interval [CI] 91.8%-95.4%]). Different types of miscarriage were also reliably identified; spontaneous abortion with PPV = 85.6% (95% CI 80.9%-89.2%), missed abortion with PPV = 92.7% (95% CI 88.8%-95.3%) and blighted ovum with PPV = 91.1% (95% CI 84.3%-95.1%). The PPV of surgical treatment (62.2% [95% CI 55.7%-68.3%]) was lower than the PPV of non-surgical treatment (93.3% [95% CI 90.5%-95.3%]). The diagnoses regarding adverse events of miscarriage treatment could be reliably identified. The PPV for clinical infections was 76.0% (95% CI 56.6%-88.5%) and for retained products of conception or/and vaginal bleeding 96.8% (95% CI 83.8%-99.4%). CONCLUSIONS The coverage of the NHDR was good concerning identification of miscarriages, different types of miscarriages and non-surgical treatment. Nevertheless, there is a need for clearly defined procedural codes concerning to medical treatment of miscarriage. The register-based data are reliable and practicable for both clinical evaluation and research concerning miscarriage.
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Affiliation(s)
- Nea Helle
- Department of Obstetrics and GynecologyUniversity of Helsinki, and Helsinki University HospitalHelsinkiFinland,Department of Obstetrics and GynecologyHUS Hyvinkää HospitalHyvinkääFinland
| | - Maarit Niinimäki
- Department of Obstetrics and GynecologyOulu University HospitalOuluFinland,PEDEGO Research UnitUniversity of OuluOuluFinland,Medical Research Center Oulu (MRC Oulu)University of OuluOuluFinland
| | - Reetta Linnakaari
- Department of Obstetrics and GynecologyUniversity of Helsinki, and Helsinki University HospitalHelsinkiFinland
| | - Anna But
- Department of BiostatisticsUniversity of HelsinkiHelsinkiFinland
| | - Mika Gissler
- Finnish Institute for Health and Welfare (THL)HelsinkiFinland,Departments of Molecular Medicine and Surgery, and NeurobiologyKarolinska InstituteStockholmSweden,Academic Primary Health Care CenterRegion StockholmStockholmSweden
| | - Oskari Heikinheimo
- Department of Obstetrics and GynecologyUniversity of Helsinki, and Helsinki University HospitalHelsinkiFinland
| | - Maarit Mentula
- Department of Obstetrics and GynecologyUniversity of Helsinki, and Helsinki University HospitalHelsinkiFinland
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Coomarasamy A, Gallos ID, Papadopoulou A, Dhillon-Smith RK, Al-Memar M, Brewin J, Christiansen OB, Stephenson MD, Oladapo OT, Wijeyaratne CN, Small R, Bennett PR, Regan L, Goddijn M, Devall AJ, Bourne T, Brosens JJ, Quenby S. Sporadic miscarriage: evidence to provide effective care. Lancet 2021; 397:1668-1674. [PMID: 33915095 DOI: 10.1016/s0140-6736(21)00683-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/19/2022]
Abstract
The physical and psychological effect of miscarriage is commonly underappreciated. The journey from diagnosis of miscarriage, through clinical management, to supportive aftercare can be challenging for women, their partners, and caregivers. Diagnostic challenges can lead to delayed or ineffective care and increased anxiety. Inaccurate diagnosis of a miscarriage can result in the unintended termination of a wanted pregnancy. Uncertainty about the therapeutic effects of interventions can lead to suboptimal care, with variations across facilities and countries. For this Series paper, we have developed recommendations for practice from a literature review, appraisal of guidelines, and expert group discussions. The recommendations are grouped into three categories: (1) diagnosis of miscarriage, (2) prevention of miscarriage in women with early pregnancy bleeding, and (3) management of miscarriage. We recommend that every country reports annual aggregate miscarriage data, similarly to the reporting of stillbirth. Early pregnancy services need to focus on providing an effective ultrasound service, as it is central to the diagnosis of miscarriage, and be able to provide expectant management of miscarriage, medical management with mifepristone and misoprostol, and surgical management with manual vacuum aspiration. Women with the dual risk factors of early pregnancy bleeding and a history of previous miscarriage can be recommended vaginal micronised progesterone to improve the prospects of livebirth. We urge health-care funders and providers to invest in early pregnancy care, with specific focus on training for clinical nurse specialists and doctors to provide comprehensive miscarriage care within the setting of dedicated early pregnancy units.
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Affiliation(s)
- Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Ioannis D Gallos
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
| | - Argyro Papadopoulou
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Rima K Dhillon-Smith
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Maya Al-Memar
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Jane Brewin
- Tommy's Charity, Laurence Pountney Hill, London, UK
| | - Ole B Christiansen
- Centre for Recurrent Pregnancy Loss of Western Denmark, Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
| | - Mary D Stephenson
- University of Illinois Recurrent Pregnancy Loss Program, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL, USA
| | - Olufemi T Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | - Rachel Small
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Phillip R Bennett
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Lesley Regan
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK
| | - Mariëtte Goddijn
- Center for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, Netherlands
| | - Adam J Devall
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Tom Bourne
- Tommy's National Centre for Miscarriage Research, Imperial College London, London, UK; KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Jan J Brosens
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Warwick, UK; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Siobhan Quenby
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Warwick, UK; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Zhang B, Liu H, Luo H, Li K. Automatic quality assessment for 2D fetal sonographic standard plane based on multitask learning. Medicine (Baltimore) 2021; 100:e24427. [PMID: 33530242 PMCID: PMC7850658 DOI: 10.1097/md.0000000000024427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/18/2020] [Accepted: 12/31/2020] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT The quality control of fetal sonographic (FS) images is essential for the correct biometric measurements and fetal anomaly diagnosis. However, quality control requires professional sonographers to perform and is often labor-intensive. To solve this problem, we propose an automatic image quality assessment scheme based on multitask learning to assist in FS image quality control. An essential criterion for FS image quality control is that all the essential anatomical structures in the section should appear full and remarkable with a clear boundary. Therefore, our scheme aims to identify those essential anatomical structures to judge whether an FS image is the standard image, which is achieved by 3 convolutional neural networks. The Feature Extraction Network aims to extract deep level features of FS images. Based on the extracted features, the Class Prediction Network determines whether the structure meets the standard and Region Proposal Network identifies its position. The scheme has been applied to 3 types of fetal sections, which are the head, abdominal, and heart. The experimental results show that our method can make a quality assessment of an FS image within less a second. Also, our method achieves competitive performance in both the segmentation and diagnosis compared with state-of-the-art methods.
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Affiliation(s)
- Bo Zhang
- Department of Ultrasound, West China Second Hospital, Sichuan University/ Key Laboratory of Obstetrics & Gynecology, Pediatric Diseases, and Birth Defects of the Ministry of Education
| | - Han Liu
- Glasgow College, University of Electronic Science and Technology of China
| | - Hong Luo
- Department of Ultrasound, West China Second Hospital, Sichuan University/ Key Laboratory of Obstetrics & Gynecology, Pediatric Diseases, and Birth Defects of the Ministry of Education
| | - Kejun Li
- Wangwang Technology Company, Chengdu, China
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Addas JAK, Alabousi A, Almohaimede K, Abdullah P, Atri M. Evaluating the Transvaginal Ultrasound Diagnostic Criteria for Abnormal First-Trimester Pregnancy With Follow-Up Into the Third Trimester and Validation of Results. J Obstet Gynaecol Can 2020; 43:1055-1061. [PMID: 33358971 DOI: 10.1016/j.jogc.2020.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the current ultrasound diagnostic criteria for non-viable pregnancy in the first trimester. METHODS We conducted a retrospective chart review involving 3 tertiary care institutions. Consecutive first-trimester ultrasound reports between January 2013 and June 2016 were reviewed. All first-trimester ultrasound examinations performed to assess pregnancy viability with adequate imaging or clinical follow-up were included. Inclusion criteria based on follow-up were adequate imaging to document ongoing intrauterine pregnancy or clinical follow-up demonstrating viability or non-viability. Data on mean sac diameter (MSD), yolk sac presence/diameter, embryo presence/length, presence of a heartbeat, and heart rate were collected. This was followed by a retrospective validation review of another consecutive cohort. RESULTS Two hundred and forty-five examinations with a viable-pregnancy outcome and 301 examinations with a non-viable pregnancy outcome were reviewed. The main predictor of non-viable pregnancy was an MSD of ≥20 mm in the absence of a yolk sac (positive predictive value [PPV] 100%; 95% CI 93%-100%), embryo (PPV 100%; 95% CI 90%-100%), or heartbeat (PPV 100%; 95% CI 96%-100%]). Other predictors of non-viability were a measurable embryo without a yolk sac (PPV 100%; 95% CI 91%-100%), yolk sac diameter ≥8 mm (PPV 100%; 95% CI 91%-100%), and absence of heartbeat with an embryo ≥3 mm (PPV 100%; 95% CI 97%-100%). These findings were confirmed in a validation cohort of 45 viable and 53 non-viable pregnancies, with the exception of 1 case of viable pregnancy with no heartbeat and an embryo length 3.3 mm. Based on the median daily growth of 1.2 mm in the viable cohort, 21% of follow-up ultrasound examinations were performed too early for an MSD threshold of 20 mm and 55%, for an MSD threshold of 25 mm. CONCLUSION In our cohort, MSD ≥20 mm in the absence of yolk sac or an embryo with heartbeat always predicted a non-viable pregnancy.
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Affiliation(s)
- Jamil A K Addas
- Department of Medical Imaging, University of Toronto, Toronto, ON
| | - Abdullah Alabousi
- Department of Radiology, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, ON
| | | | - Peri Abdullah
- School of Kinesiology and Health Science, York University, Toronto, ON
| | - Mostafa Atri
- Department of Medical Imaging, University of Toronto, Toronto, ON; Department of Medical Imaging, Toronto General Hospital, Toronto, ON.
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Abstract
Recurrent pregnancy loss is a distressing pregnancy disorder experienced by ~2.5% of women trying to conceive. Recurrent pregnancy loss is defined as the failure of two or more clinically recognized pregnancies before 20-24 weeks of gestation and includes embryonic and fetal losses. The diagnosis of an early pregnancy loss is relatively straightforward, although progress in predicting and preventing recurrent pregnancy loss has been hampered by a lack of standardized definitions, the uncertainties surrounding the pathogenesis and the highly variable clinical presentation. The prognosis for couples with recurrent pregnancy loss is generally good, although the likelihood of a successful pregnancy depends on maternal age and the number of previous losses. Recurrent pregnancy loss can be caused by chromosomal errors, anatomical uterine defects, autoimmune disorders and endometrial dysfunction. Available treatments target the putative risk factors of pregnancy loss, although the effectiveness of many medical interventions is controversial. Regardless of the underlying aetiology, couples require accurate information on their chances of having a baby and appropriate support should be offered to reduce the psychological burden associated with multiple miscarriages. Future research must investigate the pathogenesis of recurrent pregnancy loss and evaluate novel diagnostic tests and treatments in adequately powered clinical trials.
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Liu L, Jiao Y, Li X, Ouyang Y, Shi D. Machine learning algorithms to predict early pregnancy loss after in vitro fertilization-embryo transfer with fetal heart rate as a strong predictor. Comput Methods Programs Biomed 2020; 196:105624. [PMID: 32623348 DOI: 10.1016/j.cmpb.2020.105624] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE According to previous studies, after in vitro fertilization-embryo transfer (IVF-ET) there exist a high early pregnancy loss (EPL) rate. The objectives of this study were to construct a prediction model of embryonic development by using machine learning algorithms based on historical case data, in this way doctors can make more accurate suggestions on the number of patient follow-ups, and provide decision support for doctors who are relatively inexperienced in clinical practice. METHODS We analyzed the significance of the same type of features between ongoing pregnancy samples and EPL samples. At the same time, by analyzing the correlation between days after embryo transfer (ETD) and fetal heart rate (FHR) of those normal embryo samples, a regression model between the two was established to obtain FHR model of normal development, and the residual analysis was used to further clarify the importance of FHR in predicting pregnancy outcome. Finally we applied six representative machine learning algorithms including Logistic Regression (LR), Support Vector Machine (SVM), Decision Tree (DT), Back Propagation Neural Network (BNN), XGBoost and Random Forest (RF) to build prediction models. Sensitivity was selected to evaluate prediction results, and accuracy of what each algorithm above predicted under both the conditions with and without FHR was compared as well. RESULTS There were statically significant differences in the same type of features between ongoing pregnancy samples and EPL samples, which could serve as predictors. FHR, of which the normal development showed a strong correlation with ETD, had great predictive value for embryonic development. Among the six predictive models the one predicted with the highest accuracy was Random Forest, of which recall ratio and F1 could reach 97%, and AUC could reach 0.97, FHR taken into account as a feature. In addition, Random Forest had a higher prediction accuracy rate for samples with longer ETD-its accuracy rate could reach 99% when predicting those at 10 weeks after embryo transfer. CONCLUSION In this study, we established and compared six classification models to accurately predict EPL after the appearance of embryonic cardiac activity undergoing IVF-ET. Finally, Random Forest model outperformed the others. The implementation of Random Forest model in clinical environment can assist doctors to make clinical decisions.
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Affiliation(s)
- Lijue Liu
- School of Automation, Central South University, Changsha, Hunan, 410083, China; Hunan Zixing Intelligent Medical Technology Co., Ltd, Changsha, Hunan, 410000, China
| | - Yongxia Jiao
- School of Automation, Central South University, Changsha, Hunan, 410083, China
| | - Xihong Li
- Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84, Xiangya road, Changsha city, Hunan, 410078, China.
| | - Yan Ouyang
- Reproductive and Genetic Hospital of CITIC-Xiangya, No. 84, Xiangya road, Changsha city, Hunan, 410078, China; Institute of Reproductive and Stem Cell Engineering, Central South University, No. 84, Xiangya road, Changsha city, Hunan, 410078, China
| | - Danni Shi
- School of Automation, Central South University, Changsha, Hunan, 410083, China
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Fernlund A, Jokubkiene L, Sladkevicius P, Valentin L. Predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding. Arch Gynecol Obstet 2020; 302:1279-96. [PMID: 32638095 DOI: 10.1007/s00404-020-05672-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/25/2020] [Indexed: 01/04/2023]
Abstract
Purpose To identify predictors of complete miscarriage after expectant management or misoprostol treatment of non-viable early pregnancy in women with vaginal bleeding. Methods This was a planned secondary analysis of data from a published randomized controlled trial comparing expectant management with vaginal single dose of 800 µg misoprostol treatment of women with embryonic or anembryonic miscarriage. Predefined variables—serum-progesterone, serum-β-human chorionic gonadotropin, parity, previous vaginal deliveries, gestational age, clinical symptoms (bleeding and pain), mean diameter and shape of the gestational sac, crown-rump-length, type of miscarriage, and presence of blood flow in the intervillous space—were tested as predictors of treatment success (no gestational sac in the uterine cavity and maximum anterior–posterior intracavitary diameter was ≤ 15 mm as measured with transvaginal ultrasound on a sagittal view) in univariable and multivariable logistic regression. Results Variables from 174 women (83 expectant management versus 91 misoprostol) were analyzed for prediction of complete miscarriage at ≤ 17 days. In patients managed expectantly, the rate of complete miscarriage was 62.7% (32/51) in embryonic miscarriages versus 37.5% (12/32) in anembryonic miscarriages (P = 0.02). In multivariable logistic regression, the likelihood of success increased with increasing gestational age, increasing crown-rump-length and decreasing gestational sac diameter. Misoprostol treatment was successful in 80.0% (73/91). No variable predicted success of misoprostol treatment. Conclusions Complete miscarriage after expectant management is significantly more likely in embryonic miscarriage than in anembryonic miscarriage. Gestational age, crown-rump-length, and gestational sac diameter are independent predictors of success of expectant management. Predictors of treatment success may help counselling women with early miscarriage.
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Abstract
Ultrasound is essential in the evaluation and management of pregnancies of unknown location. Differential diagnoses include early pregnancy loss, pregnancy of unknown location, and ectopic pregnancies. Both transabdominal and transvaginal routes should be available, in addition to physical examination, for complete evaluation. Diagnostic criteria for early pregnancy loss have expanded in recent years to ensure false positive results do not lead to inappropriate evacuation of desired pregnancies.
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Affiliation(s)
- Emily W Scibetta
- Department of Obstetrics and Gynecology, Harbor-UCLA, 1000 W Carson St, Torrance, CA 90509, USA.
| | - Christina S Han
- Division of Maternal-Fetal Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, Room 27-139 CHS, Los Angeles, CA 90095-1740, USA; Center for Fetal Medicine and Women's Ultrasound, 6310 San Vicente Boulevard, Suite 520, Los Angeles, CA 90048, USA
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11
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Abstract
Early in pregnancy women frequently experience nausea, vomiting, and vaginal bleeding. Nausea and vomiting can be mild, managed by dietary modifications and medications, or severe, requiring intravenous fluids and medications. Care should be used when selecting medications for nausea to avoid additional side effects or potential harm to the developing fetus. When evaluating vaginal bleeding in early pregnancy, ectopic pregnancy must be ruled out. If an intrauterine pregnancy is seen, threatened miscarriage should be considered and the patient appropriately counseled. If neither intrauterine pregnancy nor ectopic pregnancy can be established, a management algorithm for pregnancy of unknown location is presented.
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Affiliation(s)
- Elizabeth Pontius
- Department of Emergency Medicine, Georgetown University School of Medicine, MedStar Georgetown University Hospital, MedStar Washington Hospital Center, 110 Irving Street, Northwest, NA 1177, Washington, DC 20010, USA
| | - Julie T Vieth
- Department of Emergency Medicine, Canton-Potsdam Hospital, 50 Leroy Street, Potsdam, NY 13676, USA.
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Sundermann AC, Mukherjee S, Wu P, Velez Edwards DR, Hartmann KE. Gestational Age at Arrest of Development: An Alternative Approach for Assigning Time at Risk in Studies of Time-Varying Exposures and Miscarriage. Am J Epidemiol 2019; 188:570-578. [PMID: 30521025 PMCID: PMC6395168 DOI: 10.1093/aje/kwy267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 03/12/2018] [Accepted: 12/04/2018] [Indexed: 11/12/2022] Open
Abstract
The time between arrest of pregnancy development and miscarriage represents a window in which the pregnancy is nonviable and not developing. In effect, the pregnancy loss has already occurred, and additional exposure cannot influence its outcome. However, epidemiologic studies of miscarriage traditionally use gestational age at miscarriage (GAM) to assign time in survival analyses, which overestimates duration of exposure and time at risk. In Right From the Start, a pregnancy cohort study (2000-2012), we characterized the gap between estimated gestational age at arrest of development (GAAD) and miscarriage using transvaginal ultrasound in 500 women recruited from 3 states (North Carolina, Tennessee, and Texas). We compared effect estimates from models using GAAD with GAM to assign time at risk through a simulation study of several exposure patterns with varying effect sizes. The median gap between GAAD and miscarriage was 23 days (interquartile range, 15-32). Use of GAAD decreased the bias and variance of the estimated association for time-varying exposures, whereas half the time using GAM led to estimates that differed from the true effect by more than 20%. Using GAAD to assign time at risk should result in more accurate and consistent characterization of miscarriage risk associated with time-varying exposures.
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Affiliation(s)
- Alexandra C Sundermann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Sudeshna Mukherjee
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Pingsheng Wu
- Department of Biostatistics, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, School of Medicine, Vanderbilt University, Nashville, Tennessee
- Department of Bioinformatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, School of Medicine, Vanderbilt University, Nashville, Tennessee
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AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations. J Ultrasound Med 2018; 37:E13-24. [PMID: 30308091 DOI: 10.1002/jum.14831] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Abstract
Miscarriage is a frequent complication of human pregnancy: ∼50% to 70% of spontaneous conceptions are lost prior to the second trimester. Etiology of miscarriage includes genetic abnormalities, infections, immunological and implantation disorders, uterine and endocrine abnormalities, and lifestyle factors. Given such variability, knowledge regarding causes, pathophysiological mechanisms, and morphologies of primary early pregnancy loss has significant gaps; often, pregnancy losses remain unexplained. Pathologic evaluation of miscarriage tissue is an untapped source of knowledge. Although miscarriage specimens comprise a significant part of pathologists' workload, information reported from these specimens is typically of minimal clinical utility for delineating etiology or predicting recurrence risk. Standardized terminology is available, though not universally used. We reintroduce the terminology and review new information about early pregnancy losses and their morphologies. Current clinical terminology is inconsistent, hampering research progress. This review is a resource for diagnostic pathologists studying this complex problem.
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Affiliation(s)
- M Halit Pinar
- a Perinatal and Pediatric Pathology , Warren Alpert Medical School, Brown University , Providence , Rhode Island , USA
| | - Karen Gibbins
- b Division of Maternal and Fetal Medicine , University of Utah Hospital, Obstetrics and Gynecology , Salt Lake City , Utah , USA
| | - Mai He
- c Pathology and Laboratory Medicine, Division of Pediatric Pathology , Washington University in Saint Louis School of Medicine , Saint Louis , Missouri , USA
| | - Stefan Kostadinov
- d Pathology and Laboratory Medicine, Division of Perinatal and Pediatric Pathology, Women and Infants Hospital , Brown University Warren Alpert Medical School , Providence , Rhode Island , USA
| | - Robert Silver
- e Division of Maternal Fetal Medicine , University of Utah Hospital, Obstetrics and Gynecology , Salt Lake City , Utah , USA
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Fernlund A, Jokubkiene L, Sladkevicius P, Valentin L. Misoprostol treatment vs expectant management in women with early non-viable pregnancy and vaginal bleeding: a pragmatic randomized controlled trial. Ultrasound Obstet Gynecol 2018; 51:24-32. [PMID: 29072372 DOI: 10.1002/uog.18940] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To compare vaginal misoprostol treatment with expectant management in early non-viable pregnancy with vaginal bleeding with regard to complete evacuation of the uterine cavity within 10 days after randomization. METHODS This was a parallel randomized controlled, open-label trial conducted in Skåne University Hospital, Sweden. Patients with anembryonic pregnancy or early fetal demise (crown-rump length ≤ 33 mm) and vaginal bleeding were randomly allocated to either expectant management or treatment with a single dose of 800 μg misoprostol administered vaginally. Patients were evaluated clinically and by ultrasound until complete evacuation of the uterus was achieved (no gestational sac in the uterine cavity and maximum anteroposterior diameter of the intracavitary contents < 15 mm as measured by transvaginal ultrasound on midsagittal view). Follow-up visits were planned at 10, 17, 24 and 31 days. Dilatation and evacuation (D&E) was recommended if miscarriage was not complete within 31 days, but was performed earlier at patient's request, or if there was excessive bleeding as judged clinically. Analysis was by intention to treat. The main outcome measure was number of patients with complete miscarriage without D&E ≤ 10 days. RESULTS Ninety-four patients were randomized to misoprostol treatment and 95 to expectant management. After exclusion of three patients and withdrawal of consent by two patients in the expectant management group, 90 women were included in this group. Miscarriage was complete ≤ 10 days in 62/94 (66%) of the patients in the misoprostol group and in 39/90 (43%) of those in the group managed expectantly (risk difference (RD) = 23%; 95% CI, 8-37%). At 31 days, the corresponding figures were 81/94 (86%) and 55/90 (61%) (RD = 25%; 95% CI, 12-38%). Two patients from each group underwent emergency D&E because of excessive bleeding and one of these in each group received blood transfusion. The number of patients undergoing D&E at their own request was higher in the expectantly managed group, 15/90 (17%) vs 3/94 (3%) in the misoprostol group (RD = 14%; 95% CI, 4-23%), as was the number of patients making out-of-protocol visits, 50/90 (56%) vs 27/94 (29%) (RD = 27%; 95% CI, 12-40%). Compared with the expectant management group, more patients in the misoprostol group experienced pain (71/77 (92%) vs 91/91 (100%); RD = 8%; 95% CI, 1-17%) and used painkillers (59/77 (77%) vs 85/91 (93%); RD = 17%; 95% CI, 5-29%). No major side effect was reported in any group. CONCLUSIONS In women with early non-viable pregnancy and vaginal bleeding, misoprostol treatment is more effective than is expectant management for complete evacuation of the uterus. Both methods are safe but misoprostol treatment is associated with more pain than is expectant management. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A Fernlund
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - L Jokubkiene
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - P Sladkevicius
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
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Indiran V, Kokilavani J. Diamond ring sign. Abdom Radiol (NY) 2017; 42:2778. [PMID: 28555263 DOI: 10.1007/s00261-017-1197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Richardson A, Deb S, Campbell B, Raine-Fenning N. Serum concentrations of Ang-2 and Flt-1 may be predictive of pregnancy outcome in women with pregnancies of uncertain viability: a phase I exploratory prognostic factor study. J OBSTET GYNAECOL 2017; 38:321-326. [DOI: 10.1080/01443615.2017.1353596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alison Richardson
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Shilpa Deb
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Bruce Campbell
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nick Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
- Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Yi Y, Li X, Ouyang Y, Lin G, Lu G, Gong F. Discriminant analysis forecasting model of first trimester pregnancy outcomes developed by following 9,963 infertile patients after in vitro fertilization. Fertil Steril 2016; 105:1261-5. [DOI: 10.1016/j.fertnstert.2016.01.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/21/2016] [Accepted: 01/25/2016] [Indexed: 11/19/2022]
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Yi Y, Lu G, Ouyang Y, lin G, Gong F, Li X. A logistic model to predict early pregnancy loss following in vitro fertilization based on 2601 infertility patients. Reprod Biol Endocrinol 2016; 14:15. [PMID: 27036944 PMCID: PMC4818412 DOI: 10.1186/s12958-016-0147-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/04/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND According to previous studies, even after embryonic cardiac activity is detected, the pregnancy loss rate remains 3-4 %. The objectives of this study were to investigate the differences in ultrasound parameters between a miscarriage group and an ongoing pregnancy group during the 1(st) trimester and to build a logistic model to predict early pregnancy loss (EPL) after the appearance of embryonic cardiac activity in patients who have undergone in vitro fertilization embryo transfer (IVF-ET) treatment. METHOD A total of 2601 patients with early singleton pregnancies with embryonic cardiac activity were retrospectively analyzed after IVF from January 2010 to June 2011. Transvaginal sonography (TVS) was performed at 6 to 10 weeks of gestational age (GA). The mean gestational sac diameter (MSD), crown-rump length (CRL), fetal heart rate (FHR), and yolk sac diameter (YSD) were measured by TVS. RESULTS A total of 2400 patients had an ongoing pregnancy and an additional 201 (7.7 %) patients miscarried during the first trimester after fetal cardiac activity had been established. The maternal age (MA) and infertility duration were much greater, and the MSD, CRL, and FHR were much lower in the miscarriage group than in the ongoing pregnancy group after IVF (P < 0.05). The prediction model utilized the following equation: the possibility of EPL = exp(z)/(1 + exp(z)), where z = -21.456 + (0.114 × MA) + (4.305 × × GA) - (0.043 × MSD) - (0.359 × CRL) - (0.091 × FHR) + 2.243 (fluid collection present around the gestational sac (GS)) + 2.519 (when YSD < 3) or - 0.347 (when YSD > 5.5). CONCLUSION The MA, MSD, CRL, YSD, FHR, infertility duration, and fluid collection around the GS were each correlated with EPL after IVF in infertile patients. A logistic model is a useful tool for predicting EPL after the appearance of embryonic cardiac activity (area under the curve [AUC] = 0.909).
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Affiliation(s)
- Yan Yi
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road, Changsha, 410078 Hunan P. R. China
| | - Guangxiu Lu
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road, Changsha, 410078 Hunan P. R. China
- Reproductive and Genetic Hospital of CITIC-Xiangya, Xiangya Road, Changsha, 410078 Hunan P. R. China
| | - Yan Ouyang
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road, Changsha, 410078 Hunan P. R. China
- Reproductive and Genetic Hospital of CITIC-Xiangya, Xiangya Road, Changsha, 410078 Hunan P. R. China
| | - Ge lin
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road, Changsha, 410078 Hunan P. R. China
- Reproductive and Genetic Hospital of CITIC-Xiangya, Xiangya Road, Changsha, 410078 Hunan P. R. China
| | - Fei Gong
- Institute of Reproductive and Stem Cell Engineering, Central South University, Xiangya Road, Changsha, 410078 Hunan P. R. China
- Reproductive and Genetic Hospital of CITIC-Xiangya, Xiangya Road, Changsha, 410078 Hunan P. R. China
| | - Xihong Li
- Reproductive and Genetic Hospital of CITIC-Xiangya, Xiangya Road, Changsha, 410078 Hunan P. R. China
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Affiliation(s)
- Tom Bourne
- Tommy's National Miscarriage Centre; Queen Charlotte's & Chelsea Hospital, Imperial College; London UK
- KU Leuven; Leuven Belgium
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Abstract
Introduction: With the publication of four papers in late 2011, international cut‐offs for definitions of non‐viability in the first trimester of pregnancy were challenged. These definitions were inconsistent across different international guidelines. For example, a gestational sac with absent yolk sac or embryo and a mean diameter of ≥ 16 mm would be classified as a miscarriage in the USA, whereas the same sac would have to measure ≥ 20 mm in the UK or Australia to meet this definition. Likewise, an embryo with no detectable heartbeat and a CRL of ≥ 5 mm would also meet criteria for missed miscarriage in the USA, compared to a CRL ≥ 6 mm in the UK or Australia. Methods: Later in 2011 and then in 2012, guidelines across the three countries were updated and are now consistent, defining an empty gestational sac with a mean diameter of > 25 mm as a non‐viable pregnancy and/or an embryo with CRL > 7 mm and no detectable heartbeat. In this paper we explore the rationale that led to these changes in order to potentially avoid wrongly diagnosing miscarriage at the decision boundary measurements and in turn avoiding inadvertent termination of potentially viable pregnancies. Conclusion: Although reducing women's anxiety and making a definitive diagnosis as early as possible is desirable, the need for absolute certainty is paramount before diagnosis of the death of an early pregnancy is made.
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Affiliation(s)
- Fernando Infante
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales Australia
| | - Ishwari Casikar
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales Australia
| | - Uche Menakaya
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Sydney Medical School Nepean University of Sydney Nepean Hospital Penrith New South Wales Australia
| | - George Condous
- Acute GynaecologyEarly Pregnancy and Advanced Endosurgery UnitSydney Medical School NepeanUniversity of SydneyNepean HospitalPenrithNew South WalesAustralia; OMNI Gynaecological CareCentre for Women's Ultrasound and Early Pregnancy St LeonardsSydneyNew South WalesAustralia
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Ashoush S, Abuelghar W, Tamara T, Aljobboury D. Relation between types of yolk sac abnormalities and early embryonic morphology in first-trimester missed miscarriage. J Obstet Gynaecol Res 2015; 42:21-8. [DOI: 10.1111/jog.12837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/14/2015] [Accepted: 07/18/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Sherif Ashoush
- Department of Obstetrics and Gynecology, Faculty of Medicine; Ain Shams University; Cairo Egypt
| | - Wessam Abuelghar
- Department of Obstetrics and Gynecology, Faculty of Medicine; Ain Shams University; Cairo Egypt
| | - Tarek Tamara
- Department of Obstetrics and Gynecology, Faculty of Medicine; Ain Shams University; Cairo Egypt
| | - Dalia Aljobboury
- Department of Obstetrics and Gynecology; Fallujah Hospital; Fallujah Iraq
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Affiliation(s)
- Bassem Gerges
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Kingswood, New South Wales, Australia.
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Kingswood, New South Wales, Australia.,Omni Gynaecological Care Centre for Women's Ultrasound and Early Pregnancy, St Leonards, New South Wales, Australia
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Preisler J, Kopeika J, Ismail L, Vathanan V, Farren J, Abdallah Y, Battacharjee P, Van Holsbeke C, Bottomley C, Gould D, Johnson S, Stalder C, Van Calster B, Hamilton J, Timmerman D, Bourne T. Defining safe criteria to diagnose miscarriage: prospective observational multicentre study. BMJ 2015; 351:h4579. [PMID: 26400869 PMCID: PMC4580727 DOI: 10.1136/bmj.h4579] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To validate recent guidance changes by establishing the performance of cut-off values for embryo crown-rump length and mean gestational sac diameter to diagnose miscarriage with high levels of certainty. Secondary aims were to examine the influence of gestational age on interpretation of mean gestational sac diameter and crown-rump length values, determine the optimal intervals between scans and findings on repeat scans that definitively diagnose pregnancy failure.) DESIGN Prospective multicentre observational trial. SETTING Seven hospital based early pregnancy assessment units in the United Kingdom. PARTICIPANTS 2845 women with intrauterine pregnancies of unknown viability included if transvaginal ultrasonography showed an intrauterine pregnancy of uncertain viability. In three hospitals this was initially defined as an empty gestational sac <20 mm mean diameter with or without a visible yolk sac but no embryo, or an embryo with crown-rump length <6 mm with no heartbeat. Following amended guidance in December 2011 this definition changed to a gestational sac size <25 mm or embryo crown-rump length <7 mm. At one unit the definition was extended throughout to include a mean gestational sac diameter <30 mm or embryo crown-rump length <8 mm. MAIN OUTCOME MEASURES Mean gestational sac diameter, crown-rump length, and presence or absence of embryo heart activity at initial and repeat transvaginal ultrasonography around 7-14 days later. The final outcome was pregnancy viability at 11-14 weeks' gestation. RESULTS The following indicated a miscarriage at initial scan: mean gestational sac diameter ≥ 25 mm with an empty sac (364/364 specificity: 100%, 95% confidence interval 99.0% to 100%), embryo with crown-rump length ≥ 7 mm without visible embryo heart activity (110/110 specificity: 100%, 96.7% to 100%), mean gestational sac diameter ≥ 18 mm for gestational sacs without an embryo presenting after 70 days' gestation (907/907 specificity: 100%, 99.6% to 100%), embryo with crown-rump length ≥ 3 mm without visible heart activity presenting after 70 days' gestation (87/87 specificity: 100%, 95.8% to 100%). The following were indicative of miscarriage at a repeat scan: initial scan and repeat scan after seven days or more showing an embryo without visible heart activity (103/103 specificity: 100%, 96.5% to 100%), pregnancies without an embryo and mean gestational sac diameter <12 mm where the mean diameter has not doubled after 14 days or more (478/478 specificity: 100%, 99.2% to 100%), pregnancies without an embryo and mean gestational sac diameter ≥ 12 mm showing no embryo heartbeat after seven days or more (150/150 specificity: 100%, 97.6% to 100%). CONCLUSIONS Recently changed cut-off values of gestational sac and embryo size defining miscarriage are appropriate and not too conservative but do not take into account gestational age. Guidance on timing between scans and expected findings on repeat scans are still too liberal. Protocols for miscarriage diagnosis should be reviewed to account for this evidence to avoid misdiagnosis and the risk of terminating viable pregnancies.
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Affiliation(s)
- Jessica Preisler
- Queen Charlotte's and Chelsea Hospital, Imperial College, London W12 0HS, UK
| | - Julia Kopeika
- Early Pregnancy and Acute Gynaecology Unit, St Thomas' Hospital, London, UK
| | - Laure Ismail
- Queen Charlotte's and Chelsea Hospital, Imperial College, London W12 0HS, UK St Mary's Hospital, Imperial College NHS Trust, London, UK
| | | | - Jessica Farren
- Queen Charlotte's and Chelsea Hospital, Imperial College, London W12 0HS, UK
| | - Yazan Abdallah
- Queen Charlotte's and Chelsea Hospital, Imperial College, London W12 0HS, UK
| | | | - Caroline Van Holsbeke
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | | | - Deborah Gould
- St Mary's Hospital, Imperial College NHS Trust, London, UK
| | | | - Catriona Stalder
- Queen Charlotte's and Chelsea Hospital, Imperial College, London W12 0HS, UK
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Belgium
| | - Judith Hamilton
- Early Pregnancy and Acute Gynaecology Unit, St Thomas' Hospital, London, UK
| | - Dirk Timmerman
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium Department of Development and Regeneration, KU Leuven, Belgium
| | - Tom Bourne
- Queen Charlotte's and Chelsea Hospital, Imperial College, London W12 0HS, UK Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium Department of Development and Regeneration, KU Leuven, Belgium
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Affiliation(s)
- Maya Al-Memar
- Early Pregnancy & Acute Gynaecology Unit; Queen Charlotte's & Chelsea Hospital, Imperial College; Du Cane Road London W12 0HS UK
| | - Emma Kirk
- North Middlesex University Hospital; Sterling Way London N18 1QX UK
| | - Tom Bourne
- Queen Charlotte's & Chelsea Hospital, Imperial College; Du Cane Road London W12 0HS
- Imperial College; London
- KU Leuven; Belgium
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van der Pol CB, McInnes MDF, Petrcich W, Tunis AS, Hanna R. Is quality and completeness of reporting of systematic reviews and meta-analyses published in high impact radiology journals associated with citation rates? PLoS One 2015; 10:e0119892. [PMID: 25775455 PMCID: PMC4361663 DOI: 10.1371/journal.pone.0119892] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 01/20/2015] [Indexed: 01/01/2023] Open
Abstract
Purpose The purpose of this study is to determine whether study quality and completeness of reporting of systematic reviews (SR) and meta-analyses (MA) published in high impact factor (IF) radiology journals is associated with citation rates. Methods All SR and MA published in English between Jan 2007–Dec 2011, in radiology journals with an IF >2.75, were identified on Ovid MEDLINE. The Assessing the Methodologic Quality of Systematic Reviews (AMSTAR) checklist for study quality, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for study completeness, was applied to each SR & MA. Each SR & MA was then searched in Google Scholar to yield a citation rate. Spearman correlation coefficients were used to assess the relationship between AMSTAR and PRISMA results with citation rate. Multivariate analyses were performed to account for the effect of journal IF and journal 5-year IF on correlation with citation rate. Values were reported as medians with interquartile range (IQR) provided. Results 129 studies from 11 journals were included (50 SR and 79 MA). Median AMSTAR result was 8.0/11 (IQR: 5–9) and median PRISMA result was 23.0/27 (IQR: 21–25). The median citation rate for SR & MA was 0.73 citations/month post-publication (IQR: 0.40–1.17). There was a positive correlation between both AMSTAR and PRISMA results and SR & MA citation rate; ρ=0.323 (P=0.0002) and ρ=0.327 (P=0.0002) respectively. Positive correlation persisted for AMSTAR and PRISMA results after journal IF was partialed out; ρ=0.243 (P=0.006) and ρ=0.256 (P=0.004), and after journal 5-year IF was partialed out; ρ=0.235 (P=0.008) and ρ=0.243 (P=0.006) respectively. Conclusion There is a positive correlation between the quality and the completeness of a reported SR or MA with citation rate which persists when adjusted for journal IF and journal 5-year IF.
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Affiliation(s)
| | - Matthew D. F. McInnes
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- * E-mail:
| | - William Petrcich
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adam S. Tunis
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Ramez Hanna
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
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Bourne T. A missed opportunity for excellence: the NICE guideline on the diagnosis and initial management of ectopic pregnancy and miscarriage. J Fam Plann Reprod Health Care 2014; 41:13-9. [PMID: 25512352 DOI: 10.1136/jfprhc-2014-101025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Tom Bourne
- Adjunct Professor and Consultant Gynaecologist, Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK and Visiting Professor, Department of Development and Regeneration, KU Leuven, Belgium
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Lavoué V, Huchon C, Deffieux X, Voltzenlogel MC, Vandenbroucke L, Levêque J. Recommandations françaises pour les critères diagnostiques d’arrêt de grossesse au premier trimestre et stratégie de prise en charge des patientes présentant une menace de fausse couche ou une grossesse arrêtée (hors évacuation utérine). ACTA ACUST UNITED AC 2014; 43:776-93. [DOI: 10.1016/j.jgyn.2014.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Hu M, Poder L, Filly RA. Impact of new society of radiologists in ultrasound early first-trimester diagnostic criteria for nonviable pregnancy. J Ultrasound Med 2014; 33:1585-1588. [PMID: 25154939 DOI: 10.7863/ultra.33.9.1585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES New early first-trimester diagnostic criteria for nonviable pregnancy recommended by the Society of Radiologists in Ultrasound via a multispecialty consensus panel extended the diagnostic size criteria of crown-rump length from 5 to 7 mm for embryos without a heartbeat and mean sac diameter from 16 to 25 mm for "empty" sacs. Our study assessed the potential impact of the new criteria on the number of additional follow-up sonograms these changes would engender. METHODS A retrospective study of all first-trimester sonograms in women with first trimester bleeding from 1999 to 2008 was conducted. Everyone included in the study had a visible gestational sac in the uterus. There were no pregnancies of unknown location or ectopic pregnancies included in this study cohort. Pregnancy of unknown location was used to describe cases in which there were no signs of pregnancy inside or outside the uterus on transvaginal sonography despite a positive pregnancy test result. A total of 1013 patients met the inclusion criteria. RESULTS Seven hundred fifty-two patients (74%) had identifiable embryos, and 261 (26%) did not. Of those with an identifiable embryo, 286 (38%) had no detectable embryonic cardiac activity. The breakdown of crown-rump lengths in this group was as follows: 100 measuring less than 5 mm, 36 measuring 5 to 7 mm, and 150 measuring 7 mm or greater. The breakdown of mean sac diameters in those without a visible embryo was as follows: 120 measuring less than 16 mm, 90 measuring 16 to 25 mm, and 51 measuring 25 mm or greater. CONCLUSIONS When diagnosing a failed pregnancy, there can be no room for error. Only 126 of 1013 early pregnancies threatening to abort (12%) fell into the more conservative zones defined by the new compared to the former size criteria (crown-rump length, 5-7 mm; mean sac diameter, 16-25 mm). Therefore, the potential impact of the new guidelines on follow-up sonograms does not appear inordinate.
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Affiliation(s)
- Maowen Hu
- Department of Radiology, University of California, San Francisco, California USA
| | - Liina Poder
- Department of Radiology, University of California, San Francisco, California USA.
| | - Roy A Filly
- Department of Radiology, University of California, San Francisco, California USA
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Knez J, Day A, Jurkovic D. Ultrasound imaging in the management of bleeding and pain in early pregnancy. Best Pract Res Clin Obstet Gynaecol 2014; 28:621-36. [PMID: 24841987 DOI: 10.1016/j.bpobgyn.2014.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/16/2014] [Accepted: 04/10/2014] [Indexed: 12/27/2022]
Abstract
Bleeding and pain are experienced by 20% of women during the first trimester of pregnancy. Although most pregnancies complicated by pain and bleeding tend to progress normally, these symptoms are distressing for woman, and they are also associated with an increased risk of miscarriage and ectopic pregnancy. Ultrasound is the first and often the only diagnostic modality that is used to determine location of early pregnancy and to assess its health. Ultrasound is an accurate, safe, painless and relatively inexpensive diagnostic tool, which all contributed to its widespread use in early pregnancy. Pain and bleeding in early pregnancy are sometimes caused by concomitant gynaecological, gastrointestinal, and urological problems, which could also be detected on ultrasound scan. In women with suspected intra-abdominal bleeding, ultrasound scan can be used to detect the presence of blood and provide information about the extent of bleeding. In this chapter, we comprehensively review the use of ultrasound in the diagnosis and management of early pregnancy complications. We include information about the diagnosis of gynaecological and other pelvic abnormalities, which could cause pain or bleeding in pregnancy. We also provide a summary of the current views on the safety of ultrasound in early pregnancy.
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Affiliation(s)
- Jure Knez
- Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College Hospital, 235 Euston Road, London NW1 2BU, UK
| | - Andrea Day
- Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College Hospital, 235 Euston Road, London NW1 2BU, UK
| | - Davor Jurkovic
- Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College Hospital, 235 Euston Road, London NW1 2BU, UK.
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Metcalfe A, Lyon AW, Johnson JA, Bernier F, Currie G, Lix LM, Tough SC. Improving completeness of ascertainment and quality of information for pregnancies through linkage of administrative and clinical data records. Ann Epidemiol 2013; 23:444-7. [PMID: 23790349 DOI: 10.1016/j.annepidem.2013.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Birth cohorts are a common tool used in epidemiological studies about pregnancy; yet these datasets systematically miss pregnancies that are spontaneously lost or terminated. This study examined the feasibility of linking administrative and clinical datasets from Alberta Canada to identify a pregnancy cohort that includes spontaneous and medical pregnancy losses. METHODS Deterministic linkage was used to link data from twelve clinical and administrative datasets for women who conceived between November 2007 and February 2008. Descriptive statistics were used to characterize the relative contribution of each dataset to the overall dataset. RESULTS Overall, 6,477 unique pregnancies were eligible for inclusion, resulting in a live birth rate of 94.1%, a stillbirth rate of 0.5%, a fetal death rate of 4.1%, and an estimated 1.3% of the cohort moving out of the study area. No single dataset could identify all pregnancies. Individual databases identified 2.0-99.1% of the cohort. Fetal deaths were most frequently identified in outpatient physician claims, emergency room visits, ultrasound data, or from the cytogenetic laboratory. CONCLUSIONS Linkage of clinical and administrative databases to identify pregnancy is feasible and can overcome many limitations associated with the use of a single dataset; however, fetal deaths continue to be under-ascertained.
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Affiliation(s)
- Amy Metcalfe
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
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Tunis AS, McInnes MDF, Hanna R, Esmail K. Association of Study Quality with Completeness of Reporting: Have Completeness of Reporting and Quality of Systematic Reviews and Meta-Analyses in Major Radiology Journals Changed Since Publication of the PRISMA Statement? Radiology 2013; 269:413-26. [DOI: 10.1148/radiol.13130273] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Doubilet PM, Benson CB, Bourne T, Blaivas M, Barnhart KT, Benacerraf BR, Brown DL, Filly RA, Fox JC, Goldstein SR, Kendall JL, Lyons EA, Porter MB, Pretorius DH, Timor-Tritsch IE. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 2013; 369:1443-51. [PMID: 24106937 DOI: 10.1056/nejmra1302417] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Peter M Doubilet
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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Guha S, Van Belle V, Bottomley C, Preisler J, Vathanan V, Sayasneh A, Stalder C, Timmerman D, Bourne T. External validation of models and simple scoring systems to predict miscarriage in intrauterine pregnancies of uncertain viability. Hum Reprod 2013; 28:2905-11. [DOI: 10.1093/humrep/det342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Bourne T, Bottomley C. When is a pregnancy nonviable and what criteria should be used to define miscarriage? Fertil Steril 2012; 98:1091-6. [PMID: 23084011 DOI: 10.1016/j.fertnstert.2012.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 09/14/2012] [Accepted: 09/17/2012] [Indexed: 11/23/2022]
Abstract
In 2011, the first systematic review of the evidence behind the diagnostic criteria for miscarriage was published. It states, "findings were limited by the small number and poor quality of the studies," and concluded that further studies were, "urgently required before setting future standards for the accurate diagnosis of early embryonic demise." This implies that data used to define criteria to diagnose miscarriage are unreliable. The 2011 Irish Health Service executive review into miscarriage misdiagnosis highlighted this issue. In parallel to these publications a multicenter prospective study was published examining cut-off values for mean sac diameter (MSD) and embryo size to define miscarriage. The authors also published evidence on expected findings when ultrasonography is repeated at an interval. This led to guidance on diagnostic criteria for miscarriage in the UK changing. These new criteria state miscarriage be considered only when: an empty gestation sac has an MSD of ≥ 25 mm (with no obvious yolk sac), or embryonic crown rump length ≥ 7 mm (the latter without evidence of fetal heart activity). If in doubt, repeating scans at an interval is emphasized. It is axiomatic that decisions about embryonic viability must not be open to doubt. So it is surprising how little evidence exists to support previous guidance. Any clinician working in this area knows of women being wrongly informed that their pregnancy has failed. This cannot be acceptable and guidance in this area must be "failsafe."
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Bickhaus J, Perry E, Schust DJ. Re-examining Sonographic Cut-off Values for Diagnosing Early Pregnancy Loss. Gynecol Obstet (Sunnyvale) 2013; 3:141. [PMID: 25045591 DOI: 10.4172/2161-0932.1000141] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jennifer Bickhaus
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, USA
| | - Erin Perry
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, USA
| | - Danny J Schust
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, USA
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Hall R, Byrn FW, Philippides S. 3D Volume Assessment of a Cornual Heterotopic Double Anembryonic Gestation and Response to Methotrexate Treatment. Journal of Diagnostic Medical Sonography 2012. [DOI: 10.1177/8756479312449694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A pregnancy developing in the cornu is rare and accounts for less than 1% to 4% of ectopic pregnancies. This case describes a cornual heterotopic gestation occurring as a first pregnancy where both gestational sacs were anembryonic. Presented are subsequent 2D and 3D sonographic findings with laboratory changes following treatment in an ectopic systemic methotrexate protocol.
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Affiliation(s)
- Rebecca Hall
- Division of Maternal Fetal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Francis W. Byrn
- Division of Reproductive Endocrinology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Stephanie Philippides
- Division of Maternal Fetal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
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Ballard J, Graf C, Young C. Measuring Clinical Relevance and Impact in Journal Publishing: A Proposed Model and Publisher's Perspective. Clin Ther 2011; 33:B11-5. [DOI: 10.1016/j.clinthera.2011.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 10/31/2011] [Accepted: 11/02/2011] [Indexed: 11/25/2022]
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