ULTRASONOGRAPHY AND PREGNANCY OUTCOMES IN CASES OF THREATENED ABORTION: A PROSPECTIVE OBSERVATIONAL STUDY

Maryam  Quadri

doi:10.51168/sjhrafrica.v5i12.1448

Authors

Maryam Quadri MBBS, Deccan College of Medical Sciences, Hyderabad, India

DOI:

https://doi.org/10.51168/sjhrafrica.v5i12.1448

Keywords:

Threatened Miscarriage, Ultrasound Parameters, Pregnancy Outcomes, Fetal Heart Rate, Gestational Sac Diameter, Predictive Modelling

Abstract

Background

Threatened miscarriage, characterized by vaginal bleeding in early pregnancy, is a common complication that can significantly impact maternal and fetal outcomes. The ability to accurately predict pregnancy loss is crucial for effective clinical management. This study aims to evaluate the diagnostic performance of early ultrasound parameters in predicting pregnancy outcomes among women presenting with threatened miscarriage.

Methods

A prospective observational study was conducted involving 200 patients diagnosed with threatened miscarriage at a tertiary care center. Inclusion criteria included normal body mass index (BMI), a known last menstrual period (LMP), absence of cervical pathology, and a single viable pregnancy. Participants were divided into three groups: Group I (pregnancy loss), Group II (ongoing pregnancy), and Group III (control group). Ultrasound examinations were performed to assess fetal heart rate (FHR), gestational sac diameter (GSD), crown-rump length (CRL), and yolk sac diameter (YSD). Maternal and neonatal outcomes were recorded, and statistical analyses were performed using SPSS 10.

Results

Among the participants, 30% experienced pregnancy loss (Group I), while 70% continued their pregnancies (Group II). Significant differences were observed in ultrasound parameters, with Group I showing lower FHR (mean 98.2 bpm) and smaller GSD (mean 14.5 mm) compared to Groups II and III. The diagnostic performance of FHR <100 bpm and GSD <15 mm was found to be highly predictive of miscarriage, with sensitivities of 85% and 80%, respectively.

Conclusion

Early ultrasound parameters, particularly FHR and GSD, are valuable indicators of pregnancy outcomes in cases of threatened miscarriage. Their predictive capabilities can guide clinical management, allowing for closer monitoring and tailored interventions.

Recommendations

It is recommended that clinicians utilize early ultrasound assessments in women presenting with threatened miscarriages to improve pregnancy outcomes. Further studies are needed to validate these findings and explore additional markers that may enhance predictive accuracy.

References

Johns J, Jauniaux E. Threatened miscarriage as a predictor of obstetric outcome. Obstetrics & Gynecology. 2006 Apr 1;107(4):845-50. https://doi.org/10.1097/01.AOG.0000206186.91335.9a

Ananth CV, Savitz DA. Vaginal bleeding and adverse reproductive outcomes: a meta‐analysis. Pediatric and perinatal epidemiology. 1994 Jan;8(1):62-78. https://doi.org/10.1111/j.1365-3016.1994.tb00436.x

Kanmaz AG, İnan AH, Beyan E, Budak A. The effects of threatened abortions on pregnancy outcomes. Ginekologia Polska. 2019;90(4):195-200. https://doi.org/10.5603/GP.a2019.0035

Pillai RN. Prediction of miscarriage in women with threatened miscarriage using a combination of biochemical and ultrasound scan markers-A prospective cohort study (Doctoral dissertation, University of Leicester).

Patki A, Chauhan N. An epidemiology study to determine the prevalence and risk factors associated with recurrent spontaneous miscarriage in India. The Journal of Obstetrics and Gynecology of India. 2016 Oct;66:310-5. https://doi.org/10.1007/s13224-015-0682-0

Ray RK, Samal S. Foetal heart rate in the first trimester threatened abortion for predicting pregnancy outcome. Journal of Evolution of Medical and Dental Sciences. 2017 May 1;6(35):2921-4. https://doi.org/10.14260/Jemds/2017/629

Abramowicz JS. Ultrasound in the First Trimester: How to Keep It Safe. InFirst-Trimester Ultrasound: A Comprehensive Guide 2023 Apr 14 (pp. 1-19). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-24133-8_1

Jauniaux E, Johns J, Burton GJ. The role of ultrasound imaging in diagnosing and investigating early pregnancy failure. Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2005 Jun;25(6):613-24. https://doi.org/10.1002/uog.1892

Wu W, Ji Q, Guo B, Yu J, Wang J, Wang Y, Xu J. Clinical value of serum homocysteine, folate, and ultrasonography detection of yolk sac in predicting the outcome of threatened abortion. Pteridines. 2019 Mar 1;30(1):10-5. https://doi.org/10.1515/pteridines-2019-0002

Aboelwan Y, Abd Elsalam WA, Hamed BM, Mohamed Z. Doppler Ultrasound Assessment In Women With Threatened Abortion. Zagazig University Medical Journal. 2022 Nov 1;28(6.2):145-51.

Wang X, Shi W, Shi J, Ding Y, Yu Z, Zhang H. Relationship between the volume ratio of subchorionic hematoma to gestation SAC in first-trimester and pregnancy outcome of patients with threatened abortion. J Coll Physicians Surg Pak. 2022 Nov 1;32(11):1415-9. https://doi.org/10.29271/jcpsp.2022.11.1415

Anter M, Shabana A, Ellakwa H, Hamza H, Omar M. Role of CA-125 and ultrasound in early prediction of outcome of threatened miscarriage. Menoufia Medical Journal. 2020 Oct 1;33(4):1258-.

Abd-el Fatah A, Megahid S. Comparative Study Between Corpus Luteum Changes in Normal Pregnancy and Threatened Abortion Using Transvaginal Color Doppler Sonography. Al-Azhar International Medical Journal. 2020 Jan 1;1(1):154-9