> Pregnancy, better to wait for the first ultrasound

current guidelines regarding the sonographic diagnosis of spontaneous abortion may still be associated with the diagnosis wrong and should be updated according to a prospective observational study, multicenter trial.

“The guidelines on the correct interval between an ultrasound scan and the other and thereò that should be expected from the ultrasound repeated are still unclear”, write the authors. “The protocols for the diagnosis of spontaneous abortion should be revised to take account of this to avoid incorrect diagnoses of miscarriage with the risk of disrupting viable pregnancies.”

Tom Bourne, consultant gynaecologist and professor, the United Kingdom of the Queen Charlotte and Chelsea Hospital, Imperial College London, and colleagues report their results in an article published on September 23 on the BMJ.

the primary Objective of the study has been to validate the recent changes of orientation with regard to the sonographic diagnosis of spontaneous abortion. These guidelines use measures of length of the embryo (CRL) and the diameter of the gestational sac (MSD); the values of cut-off have been changed in the course of 2011, but the data supporting the change have wide ranges of variabilityà.

secondary objectives were to investigate the influence of età gestational on the interpretation of the values for MSD and CRL, define the interval optimal between an ultrasound control, and identify the results of ultrasound scans that can definitively diagnose miscarriage.

The current guidelines address the problem of when to repeat the ultrasound when the vitalityà è uncertain in an early scan and how to interpret the results, but this is not è been shown that it is actually necessary, and that the best outcomes of pregnancy. Also, not c’è a guide line on how to put in relation the età gestational with the results of the ultrasound for the diagnosis of spontaneous abortion.

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The study is carried out in the seven-unità hospital clinic obstetrician in the United Kingdom. The researchers included 2845 women with pregnancies intrauterine with vitalityà unknown if the transvaginal ultrasound was dubious. The women were recruited in two waves, between September 2010 and march 2011 and between August 2011 and may 2013.

In the three hospitals, the researchers initially defined as “an intrauterine pregnancy of uncertain vitalityà” as an empty bag of gestation of less than 20 mm mean diameter with or without a yolk sac visible but no embryo or an embryo with a CRL less than 6 mm with no heartbeat. After that the guide line has been changed in December 2011, researchers have modified the definition with a MSD less than 25 mm or a CRL embryo less than 7 mm. The researchers of one of the unità, have extended the definitions of considering a MSD less than 30 mm or a CRL embryo less than 8 mm.

researchers have discovered that a early scan that shows a gestational sac vacuum of 25 mm of diameter or più grande has a specificà 100% for spontaneous abortion, così as an embryo without activity; heart with a CRL or greater than 7 mm.

After 70 days of gestation, a gestational sac vacuum of 18 mm of diameter, or più large has 100% specificà for spontaneous abortion, così as an embryo with a CRL of 3 mm or più great with no activitiesà of the heart.

In the sonograms in a pregnancy with an embryo without activity; heart in the early scan when repeated after 7 or more days più later, without changes, c’è specificà 100% for spontaneous abortion, così as a pregnancy with no embryo and MSD less than 12 mm if the size of the lot has doubled after 14 or more days, così as in pregnancies with no embryo and MSD 12 mm or più great with no embryo with activity; heart after 7 or more days.

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“in Spite of ultrasound technology, we can not deny the fact that often it is still necessary to watch and wait,” writes Elizabeth Anne McCarthy, lecturer, and Stephen Tong, professor, the Università of Melbourne, Department of Obstetrics and Gynaecology at Mercy Hospital for Women, Heidelberg, Victoria, Australia.

“In the era of the in vitro fertilization and pregnancy test home a lot of women are early for their first ultrasound examination,” the authors write. “In this way, it becomes habitual to look for signs of vitalityà embryonic at a time when the size of the gestational sac and embryo are too small to be certain whether an early pregnancy is viable or if it is verified, a miscarriage.” For this reason, women are often told to go back a week or two più late for an ultrasound later to determine if the facilities are increased.

This study “is an important step forward that provides greater certainty”, conclude the columnists.

Jeff Ecker, of the American College of Obstetrics and Gynecology, explained to Medscape Medical News, “there are many other clues that can be used in the diagnosis of spontaneous abortion, but the objectives of the authors have focused on the radiological data, to limit false positive”.

dr. Ecker has added that “In my school, we have già adopted these recommendations, but [the study] può help make others aware, or to give prominence to such criteria.”


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October 4, 2015