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Ultrasonographic factors predicting a poor outcome in pregnancies between 8 and 10 + 6 week's gestation

par Votino, Carmela ;Guizani, Meriem ;Condorelli, Margherita ;Votino, R.;Votino, Angelo;Gubana, Francesca ;Cos Sanchez, Teresa
Référence 24th World Congress on Ultrasound in Obstetrics and Gynecology(Barcelona, Spain)
Publication Publié, 2014-09-08

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Résumé :

ObjectivesThe aim of this prospective study is to assess the value of ultrasonographic findings in predicting unfavourable outcome in pregnancies between 8 and 10 + 6 weeks' gestation (WG).MethodsThis is a prospective study on live embryos between 8 and 10 + 6 WG performed in a tertiary center by a single fetal medicine specialist. The local research ethic committee approved the study protocol and patients were enrolled after an informed written consent. Embryonic crown–rump length (CRL), heart rate (HR) and yolk sac diameter (YSD) were measured and new ultrasonographic findings (embryonic skin edema and hydrothorax) were evaluated transvaginally. Fetal outcome was evaluated at 22 WG. Miscarriages, chromosomal abnormalities and fetal malformations were recorded and considered as unfavourable outcome. Logistic regression analysis was used in order to evaluate if the continuous variables CRL, HR and YSD and the categorical variables skin edema and hydrothorax have a significant effect on unfavourable outcome.ResultsFrom October 2011 and December 2013; 1318 consecutives patients with a live embryo pregnancy between 16mm and 44mm of CRL were enrolled in this prospective study. Final outcome was available in 1244 as in 74 cases patients were lost to the follow‐up. In 1182 cases, second trimester ultrasound confirmed a normal development. Follow‐up revealed a miscarriage in 29 cases, a chromosomal abnormality in 6 cases and a fetal malformation in 27 cases. Multivariate logistic regression analysis showed that in the prediction of unfavourable outcome the risk was higher when skin edema (odds ratio: 13.457) and hydrothorax (odds ratio:19.965) were found. However, CRL, HR and YSD didn't have a significant effect on the risk of unfavorable outcome.ConclusionsEarly ultrasonographic evaluation between 8 and 10 + 6 WG allows predicting the risk of poor outcome. Skin edema and bilateral hydrothorax are high predictors of miscarriage, chromosomal abnormalities and fetal malformations.