Prediction value of first trimester ultrasound parameters for pregnancy outcome

doi:10.16150/j.1671-2870.2021.05.004

Abstract

Abstract:

Objective: To explore the predictive value of ultrasonographic parameters in the first trimester pregnancy outcomes. Methods: A total of 1 651 pregnancy were enrolled, and ultrasonographic parameters including fetal heart rate(FHR), mean gestation sac diameter(MSD) and crown to rump length (CRL) at or before 7 weeks′ gestational age were measured, and the sonogram obtained at or before 13 weeks′ gestation to determine the embryo survived or demise.It revealed that 1 556 cases were classified into ongoing pregnancy group and 95 cases were into spontaneous abortion group. Results: Before 13 weeks′, the spontaneous abortion rate was 5.85% in the study. Pregnancy loss occurred in all the cases with the FHR slower than or equal to 80 bpm (100%), while in fetal with FHR>90 bpm decreased significantly (2.51%). The survival rate increased with the increase of FHR when FHR≤130 bpm, while the fetal demise rate increased as FHR>130 bpm(2.79%). The spontaneous abortion rate was 57.14% as MSD-CRL≤5 mm. The bigger the MSD-CRL was, the higher the survival rate was. Receiver operating characteristic (ROC) curve analysis demonstrated that AUC of FHR=97 bpm for poor pregnancy outcome was 0.870 (P<0.05), while sensitivity, specificity, PPV and NPV were 81.05%, 99.04%, 83.7% and 98.8% respectively. When MSD-CRL was taken as 11.3 mm, AUC for prediction of spontaneous abortion was 0.780(P<0.05), with sensitivity, specificity, PPV and NPV values were 56.84%, 89.01%, 24.00% and 97.10% respectively. When the combination of FHR and MSD-CRL, the AUC for prediction of spontaneous abortion was 0.922(P<0.05). Conclusions: The spontaneous abortion rate was 5.85% in the study. The cut-off value for FHR and MSD-CRL to predict abortion are 94 bpm and of 11.3 mm, respectively. The lower the fetal heart rate and the smaller MSD-CRL diameter are, the higher the spontaneous abortion rate will occur.

Key words: Ultrasound, Fetal heart rate, Gestation sac diameter, Crown-to-rump length, Pregnancy outcome

CLC Number:

R541.7

CAO Yunyun, WANG Guanjie, ZENG Min, WANG Haifeng, NIU Jianmei, ZHOU Leiping. Prediction value of first trimester ultrasound parameters for pregnancy outcome[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(05): 445-449.

Figures/Tables 4

References 12

[1]	Abdallah Y, Daemen A, Kirk E, et al. Limitations of current definitions of miscarriage using mean gestational sac diameter and crown-rump length measurements: a multicenter observational study[J]. Ultrasound Obstet Gynecol, 2011,38(5):497-502. doi: 10.1002/uog.10109 pmid: 21997898
[2]	Wang XH, Wang HJ, Deng XH, et al. Predictive value of ultrasound-related scoring system on embryo development in early pregnancy after IVF/ICSI: An observation of embryonic quality[J]. Taiwan J Obstet Gynecol, 2019,58(4):501-504. doi: 10.1016/j.tjog.2019.05.013 URL
[3]	Köşüş N, Köşüş A, Turhan NO. First trimester volumetric measurements: relation with hormone levels and fetal heart rate[J]. Arch Gynecol Obstet, 2012,286(2):365-372. doi: 10.1007/s00404-012-2311-9 URL
[4]	Detti L, Francillon L, Christiansen ME, et al. Early pregnancy ultrasound measurements and prediction of first trimester pregnancy loss: A logistic model[J]. Sci Rep, 2020,10(1):1545. doi: 10.1038/s41598-020-58114-3 URL
[5]	Datta MR, Raut A. Efficacy of first-trimester ultrasound parameters for prediction of early spontaneous abortion[J]. Int J Gynaecol Obstet, 2017,138(3):325-330. doi: 10.1002/ijgo.12231 URL
[6]	严英榴, 杨秀雄. 产前超声诊断学[M]. 北京: 人民卫生出版社, 2012:46-48.
[7]	Doubilet PM, Benson CB, Bourne T, et al. Diagnostic criteria for nonviable pregnancy early in the first trimester[J]. Ultrasound Q, 2014,30(1):3-9. doi: 10.1097/RUQ.0000000000000060 pmid: 24901772
[8]	Acharya G, Gui Y, Cnota W, et al. Human embryonic cardiovascular function[J]. Acta Obstet Gynecol Scand, 2016,95(6):621-628. doi: 10.1111/aogs.12860 URL
[9]	Arleo EK, Troiano RN. Outcome of early first-trimester pregnancies (<6.1 weeks) with slow embryonic heart rate[J]. AJR Am J Roentgenol, 2011,197(1):252-255. doi: 10.2214/AJR.10.4792 URL
[10]	龚晓萍, 王冠杰, 王海飞, 等. 超声监测早孕期胚胎心率对妊娠结局的预测价值[J]. 中华超声影像学杂志, 2018,27(11):982-985.
[11]	Kapfhamer JD, Palaniappan S, Summers K, et al. Diffe-rence between mean gestational sac diameter and crown-rump length as a marker of first-trimester pregnancy loss after in vitro fertilization[J]. Fertil Steril, 2018,109(1):130-136. doi: S0015-0282(17)31964-7 pmid: 29175064
[12]	王冠杰, 王海飞, 龚晓萍, 等. 超声监测早孕期胎心率变化规律的初步研究[J]. 临床超声医学杂志, 2020,22(2):139-141.

变量	存活组（n=1556）			自然流产组（n=95）			P值
变量	范围	均数（$\bar{x}±s$）	95%CI	范围	均数（$\bar{x}±s$）	95%CI	P值
孕周年龄（岁）	19~45	31.30±3.93	31.00~31.00	22~45	32.17±4.85	30.00~33.00	0.120 0
超声参数
头臀长（mm）	2~9	4.78±1.94	4.00~4.00	2~9	4.14±1.59	3.00~4.00	0.002 1
胎心率（次/min）	85~188	121.95±13.18	120.00~121.00	45~189	88.40±24.98	83.00~90.00	<0.000 1
MSD（mm）	9.33~40.00	20.10±4.22	19.33~20.00	7.33~28.00	15.65±3.87	14.15~15.67	<0.000 1
胎心率/头臀长比值	10.89~69.00	29.37±10.96	26.75~28.50	8.43~63	24.23±11.13	18.20~24.59	<0.000 1
MSD/头臀长比值	1.44~8.58	4.67±1.33	4.87~5.00	1.47~6.83	4.20±1.35	4.25~4.78	<0.000 1
MSD-头臀长（mm）	4.00~31.00	15.31±3.49	15.00~15.33	2.33~23	11.52±3.78	10.33~12.00	<0.000 1

变量	例数（n）	流产率（%）
胎心率（次/min）
≤80	33	33（100）
81~90	24	22（91.67）
91~100	57	13（22.81）
101~110	226	8（3.54）
111~120	537	6（1.12）
121~130	451	4（0.89）
131~140	177	5（2.82）
>140	146	4（2.74）
MSD-头臀长(mm)
≤5.0	7	4（57.14）
5.1~10.0	100	27（27.00）
10.1~15.0	754	47（6.23）
15.1~20.0	652	15（2.30）
20.1~25.0	122	2（1.64）
25.1~30.0	14	0（0）
30.1~35.0	2	0（0）

变量	AUC	95%CI	最佳临界值	灵敏度（%）	特异度（%）	阳性预测值（%）	阴性预测值（%）
胎心率	0.906	0.89~0.92	97	81.05	99.04	83.7	98.8
MSD-头臀长	0.780	0.76~0.80	11.3	56.84	89.01	24.0	97.1
胎心率/头臀长比值	0.654	0.63~0.68	19.25	46.32	80.53	12.7	96.1
MSD/头臀长比值	0.599	0.58~0.62	5.28	80.00	39.59	7.5	97.0

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