However, serologic markers are unspecific and can help only after a pregnancy loss has already been diagnosed. Multiple serologic and ultrasound markers have been investigated to identify pregnancies destined to be lost 7, 8. The most common cause of a first trimester pregnancy loss is embryonal genetic abnormalities, which occurs in more than 50% of the cases, with aneuploidy being the most frequent abnormality 5, 6. In fact, vaginal bleeding - a common sign of early pregnancy loss - can be confused with delayed menses and the loss remains unrecognized. The difference is explained by a later diagnosis of spontaneous pregnancy versus assisted reproduction pregnancy, and an early loss is easily overlooked. It is the most common complication of early pregnancy, affecting about 30% of pregnancies following assisted reproduction and 10% of spontaneously conceived pregnancies 2, 3, 4.
These findings have important implications for patient counseling and care planning, as well as a potential bearing on cost effectiveness within early pregnancy care.Įarly pregnancy loss - also known as pregnancy loss, fetal demise, miscarriage, or spontaneous abortion - is defined as a “nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity prior to 12 weeks and 6 days of gestation” 1. CRL and HR became abnormal at a later time in pregnancy and closer to the event. The YS reliably identified the occurrence of a miscarriage at least 7 days prior its occurrence. Our observations showed that, after 5 complete weeks’ gestation, a small GS and a large YS reliably predicted pregnancy loss. In the pregnancies which failed, all the parameters showed significant changes, with different temporal onsets: GS and YS were the first to become abnormal, deviating from normality as early as 6 weeks’ gestation (OR 0.01, 95% CI 0.0–0.09, and OR 3.36, 95% CI 1.53–7.34, respectively), followed by changes in HR, and CRL, which became evident at 7 and 8 weeks (OR 0.96, 95% CI 0.92–1.0, and OR 0.59, 95% CI 0.48–0.73, respectively). We built nomograms with the changes of the parameters evaluated in ongoing, as well as in pregnancy loss. A total of 252 patients were included, of which 199 were singleton pregnancies, 51 were twins, and 2 were triplets (304 total fetuses). Non-parametric tests and logistic regression models were used for comparisons of distributions and testing of associations. GS and YS diameter, CRL, and HR measurements were serially obtained in singleton and twin pregnancies from 6 through 10 weeks’ gestation. This was a prospective cohort study of first trimester pregnancies. Our objective was to prospectively validate the use of gestational sac (GS), yolk sac (YS) diameter, crown-rump length (CRL), and embryonal heart rate (HR) dimensions to identify early pregnancy loss.
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