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Wang XH, Wang HJ, Deng XH, Wang YL, Sun HL, Zhang XH, Li XX. Predictive value of ultrasound-related scoring system on embryo development in early pregnancy after IVF/ICSI: An observation of embryonic quality. Taiwan J Obstet Gynecol 2020; 58:501-504. [PMID: 31307741 DOI: 10.1016/j.tjog.2019.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the value of the ultrasound-related scoring system on pregnant patients receiving assisted reproductive technology (IVF/ICSI) and early pregnancy outcome. MATERIALS AND METHODS This prospective study included 208 pregnant women receiving assisted reproductive technology (IVF/ICSI). The following ultrasound parameters were measured: gestational sac size, the proportion of the embryo and gestational sac (embryo/gestational sac), yolk sac size, and fetal cardiac activity. The above data were assigned according to the ongoing pregnancy rate (up to 14 weeks), and the score increased parallel to the pregnancy rate. All patients were grouped according to their scores. RESULTS Patients with a score of 4-5 had a low ongoing pregnancy rate of 14.29%, while patients with a score of 6-7 had an ongoing pregnancy rate of 55.56%. Surprisingly, patients with a score of 8-9 had an ongoing pregnancy rate of 97.22%. In addition, it was found that the ongoing pregnancy rate was 100% (36/36) in patients with a score of 9. Conversely, there was no ongoing pregnancy in patients with a score of 4. CONCLUSION First, this scoring system is strongly associated with an ongoing pregnancy of over 14 weeks. Second, some reassurance can be given to patients with favorable ultrasound parameters, regardless of maternal age or previous pregnancy loss. Third, it would be meaningless to continue the pregnancy in patients with a score of 4, according to the scoring system. Fourth, patients without cardiac activity and embryos at days 33-35 after embryo transfer should discontinue the pregnancy, while patients with embryos should proceed with the pregnancy.
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Affiliation(s)
- Xin-Hua Wang
- Department of Reproductive Medical Center, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, PR China; Department of Reproductive Medicine, Binzhou Medical University Hospital, 661 Huanghe 2 Road, Binzhou, 256603, China
| | - Hui-Jun Wang
- Department of Reproductive Medicine, Binzhou Medical University Hospital, 661 Huanghe 2 Road, Binzhou, 256603, China
| | - Xiao-Hui Deng
- Department of Reproductive Medical Center, Qilu Hospital, Shandong University, 107 Wenhua Xi Road, Jinan, 250012, PR China.
| | - Yan-Lin Wang
- Department of Reproductive Medicine, Binzhou Medical University Hospital, 661 Huanghe 2 Road, Binzhou, 256603, China
| | - Hong-Liang Sun
- Department of Reproductive Medicine, Binzhou Medical University Hospital, 661 Huanghe 2 Road, Binzhou, 256603, China
| | - Xiang-Hui Zhang
- Department of Reproductive Medicine, Binzhou Medical University Hospital, 661 Huanghe 2 Road, Binzhou, 256603, China
| | - Xiao-Xia Li
- Community Health Service Center of Pengli Subdistrict, 681 Bohai 9 Road, Binzhou, 256600, China
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Rodgers SK, Chang C, DeBardeleben JT, Horrow MM. Normal and Abnormal US Findings in Early First-Trimester Pregnancy: Review of the Society of Radiologists in Ultrasound 2012 Consensus Panel Recommendations. Radiographics 2016; 35:2135-48. [PMID: 26562242 DOI: 10.1148/rg.2015150092] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Since being introduced more than 30 years ago, endovaginal ultrasonography (US) and quantitative testing of serum levels of the beta subunit of human chorionic gonadotropin have become the standard means of establishing the presence of normal intrauterine pregnancy (IUP), failed IUP, and ectopic pregnancy. Appropriate use of these powerful tools requires clear, standardized interpretations based on conservative criteria to protect both the pregnancy and the mother. Since diagnoses are assigned earlier and available medical treatments for ectopic pregnancy and failed IUP are expanding, emphasis must carefully shift toward watchful waiting when the mother is clinically stable and a definitive location for the pregnancy cannot be established with US. To this end and to prevent inadvertent harm to early normal pregnancies, the Society of Radiologists in Ultrasound convened a consensus panel of radiologists, obstetricians, and emergency medicine physicians in 2012 with the goal of reviewing current literature and clinical practices and formulating modern criteria and terminology for the various first-trimester outcomes.
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Affiliation(s)
- Shuchi K Rodgers
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141
| | - Crystal Chang
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141
| | - John T DeBardeleben
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141
| | - Mindy M Horrow
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141
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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] [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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