“The black box” of nonviable pregnancy in early gestation

2017 ◽  
Author(s):  
Å.S. Emelyanenko , A.Yu. Blinov , T.M. Volkovskaya
Keyword(s):  
Early Pregnancy ◽  
Ultrasound Examination ◽  
Black Box ◽  
Safety Regulation ◽  
Intrauterine Pregnancy ◽  
Early Gestation ◽  
Prognostic Criteria

The modern sonographic approach to define miscarriage in early pregnancy was shown in the article. Ultrasound diagnostic and prognostic criteria of nonviable pregnancy in early gestation were introduced. Special attention was paid to the examination`s algorithm and repeatability of ultrasound scans with suspicion of intrauterine pregnancy of uncertain viability. Also the consequences of non-following the stringent ultrasound criteria, which lead to the abortions of potentially normal pregnancies were described. Furthermore, the authors highlighted the importance of safety regulation`s aspects in ultrasound examination in early gestation. The conclusion of the importance and need in following the uniform methodological criteria in diagnostics of nonviable pregnancy has been drawn according to the analysis of world experience.

How Early Can Fetal Heart Pulsations Be Detected Reliably Using Modern Ultrasound Equipment?

Ultrasound ◽  
2008 ◽  
Vol 16 (4) ◽  
pp. 193-195 ◽  
Author(s):  
Elisabeth Ramsey ◽  
Jayne Shilitto
Keyword(s):  
Early Pregnancy ◽  
Ultrasound Examination ◽  
Cardiac Activity ◽  
National Guidelines ◽  
Initial Examination ◽  
Intrauterine Pregnancy ◽  
Crown Rump Length ◽  
Large Teaching Hospital ◽  
Actual Size

Background: Current national guidelines for the use of ultrasound in early pregnancy state that the embryonic heartbeat should be identified when the embryo measures 6 mm in length (RCOG/RCR 1995). Failure to visualise heart pulsations in embryos measuring 6 mm or less requires patients to wait 7 days for a repeat scan. Anecdotally, there is evidence to suggest that it is usually possible to see embryonic heart pulsation much earlier using modern ultrasound equipment. The aim of this study was to identify the smallest length of embryo when it is possible to always visualise heart pulsations during an ultrasound examination. Method: This was a prospective observational study of women attending the early pregnancy unit of a large teaching hospital. Women were invited to participate when a clinically indicated ultrasound examination revealed an intrauterine pregnancy with an embryo measuring 6 mm or less. All women were symptomatic, i.e. they presented with pain and/or bleeding in early pregnancy. The presence or absence of discernible embryonic cardiac activity was recorded at the initial ultrasound examination, and any follow-up ultrasound examination, along with the crown rump length (CRL) of the embryo. Results: The study sample consisted of 95 embryos with CRL range 1·2–6 mm. Visible heart pulsations were seen in 80 (84%) embryos at the initial examination. In 15 embryos, no discernible heart pulsation was noted; in all 15 cases, these pregnancies went on to miscarry: this was confirmed at a follow-up examination 7 days later. Conclusion: In early pregnancy ultrasound, cardiac activity should be visualized in all live embryos as soon as the embryo can be identified reliably. The absence of heart pulsations in very small embryos is indicative of pregnancy demise, regardless of the actual size of the embryo.

Opportunities for treating opportunistic vaginal infections during pregnancy

GYNECOLOGY ◽  
2017 ◽  
Vol 19 (6) ◽  
pp. 11-15 ◽  
Author(s):  
T E Karapetyan ◽  
V V Muravieva ◽  
A S Ankirskaya ◽  
L A Lyubasovskaya ◽  
T V Priputnevich
Keyword(s):  
Positive Result ◽  
Pregnant Women ◽  
Early Pregnancy ◽  
Premature Birth ◽  
Local Treatment ◽  
Vaginal Infections ◽  
Aerobic Vaginitis ◽  
Early Gestation ◽  
Early Stages ◽  
Intrauterine Infections

The aim of the study was to evaluate the effectiveness of treatment of women with opportunistic vaginal infections during pregnancy. Materials and methods. A prospective cohort study included 330 pregnant women, of whom 151 were diagnosed with bacterial vaginosis (BV), 37 had aerobic vaginitis (AB), 109 had vulvovaginal candidiasis (VC), 20 had a combination of VC + BV. When carrying out antibiotic therapy in the early stages of pregnancy, the principle of local treatment was observed. Results. Most often (46.0%), vaginal infections were detected when women were treated early in pregnancy. In the treatment of BV in the early stages of pregnancy with antiseptic chlorhexidine, a positive result of therapy was noted in 97.6% of women. Therapy with metronidazole or clindamycin BV in women who applied in the II and III trimesters, gave a positive result, respectively, in 90.0% and 89.5% of cases. The course of therapy with chlorhexidine pregnant women with AB was effective in 91.7% of cases with treatment in the first trimester and 92.0% in treatment in the II and III trimesters. In the treatment of VC in early pregnancy, natamycin was effective in 95.0% of women. In the II and III trimesters, econazole treatment was successful in 88.2% and 88.6%, respectively. In the treatment of combination of BV + VC in early gestation, the complex course of chlorhexidine + natamycin was effective in 76.5% of women, in II and III trimesters Neo-Penotran Forte was effective in 93.8% of pregnant women. Relapses of vaginal infections were observed in 34 pregnant women (10.3%). Superinfection with fungi was noted in 9.3% of cases of BV treatment and in 8.1% of pregnant women with AB. Among women observed from early pregnancy, there were no cases of premature birth, manifestations of intrauterine infections were noted in 5.3% of newborns. At treatment in the II and III trimesters, premature birth was in 6.5% and 13.5% of women, and manifestations of intrauterine infections - in 15.3% of newborns. Thus, microbiological monitoring of timely detection and treatment of opportunistic vaginal infections in pregnant at-risk groups showed the advisability of treating these infections in early gestation.

Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

2020 ◽  
Vol 16 ◽  
Author(s):  
Divya Mirji ◽  
Shubha Rao ◽  
Akhila Vasudeva ◽  
Roopa P.S
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Management Strategy ◽  
Transvaginal Ultrasound ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Β Hcg ◽  
Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

scholarly journals Ultrasound Evaluation of Pregnancy in the First Trimester

2010 ◽  
Vol 4 (1) ◽  
pp. 17-28 ◽  
Author(s):  
George M Graham
Keyword(s):  
Early Pregnancy ◽  
First Trimester ◽  
Transvaginal Sonography ◽  
List Type ◽  
Intrauterine Pregnancy ◽  
Ultrasound Evaluation ◽  
Early Pregnancy Failure ◽  
Ultrasound Findings ◽  
Ultrasound Technology ◽  
First Trimester Ultrasound

Abstract Improvements in ultrasound technology, including transvaginal sonography and higher frequency probes, have led to a better understanding of early pregnancy development. These advances and the increasing availability of ultrasound allow women to have an earlier and more accurate assessment of their pregnancy. First trimester sonographic signs have been identified that can be used to reassure women that their pregnancy is progressing normally or counsel them that their pregnancy will fail. In addition, first trimester ultrasound can accurately predict the type of twinning in multiple gestations, allowing for appropriate counseling and management. Objectives Know the first trimester ultrasound findings of a normal intrauterine pregnancy Understand the ultrasound findings that diagnose an early pregnancy failure Know the ultrasound criteria used to diagnose a multifetal gestation

O-234 Using serum metabolomics to identify biomarkers of viable early, intrauterine pregnancy: an untargeted 1H NMR-based approach

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
C Hill ◽  
M Phelan ◽  
A Horne ◽  
K Gemzell-Danielsson ◽  
N Tempest ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcome ◽  
1H Nmr ◽  
Early Pregnancy ◽  
Pregnancy Outcomes ◽  
Hydatidiform Mole ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Ectopic Pregnancies ◽  
Twin Pregnancies

Abstract Study question Which metabolites are associated with a viable intrauterine pregnancy (VIUP) when compared to other early pregnancy outcomes (failed intrauterine and ectopic pregnancies)? Summary answer Serum levels of four metabolites (phenylalanine, alanine, glutamate and glutamine) were significantly altered in VIUPs compared to other early pregnancy outcomes. What is known already Around 10% of all intrauterine pregnancies are lost in the first trimester. A further 1-2% of pregnancies are located outside the endometrial cavity; these ectopic pregnancies are the leading cause of maternal mortality in the first trimester of gestation. Early miscarriages may also cause significant morbidity when bleeding or infection occurs. The symptoms of miscarriages and ectopic pregnancy are often similar (pain and bleeding), however, such symptoms are also common in VIUPs. To date, no biomarkers have been identified to differentiate VIUPs from non-viable and ectopic pregnancies. Study design, size, duration This is a prospective cohort study that included 332 pregnant women at less than ten weeks of gestation, who attended the early pregnancy assessment unit (EPAU) at Liverpool Women’s Hospital with pain and/or bleeding. Participants/materials, setting, methods Blood samples were collected from the 332 pregnant women prior to final clinical diagnosis of pregnancy outcome. Serum samples were subjected to NMR metabolomics profiling (14 spectra that did not meet the recommended minimum reporting standards were removed from subsequent analysis). 1D 1H-NMR spectra were acquired at 37 °C on a 700 MHz spectrometer. Relative metabolite abundances underwent statistical analysis using MetaboAnalyst 5.0 (p-value FDR adjusted). Main results and the role of chance Final pregnancy outcomes were as follows: one hydatidiform mole (0.3%), 48 ectopic pregnancies (14.4%), three pregnancies of unknown location (PULs, 0.9%), 78 failed pregnancies of unknown location (FPULs, 23.4%), 47 miscarriages (14.1%), two vanishing twin pregnancies (0.6%) and 153 VIUPs (45.8%). Due to small sample numbers, the hydatidiform mole, PULs and vanishing twin pregnancies were excluded from further analysis. To compare VIUPs to other pregnancy outcomes, ectopic pregnancies, FPULs and miscarriages were grouped together. Univariate analysis of serum metabolite concentrations identified four metabolites (phenylalanine, alanine, glutamate and glutamine) as significantly different in VIUPs compared to other pregnancy outcomes. Multivariate partial least squared discriminant analysis provided only weak correlation between the serum metabolome and pregnancy outcome. In summary, we have identified differences in the metabolome of women with VIUPs compared to other common pregnancy outcomes, which may provide diagnostic utility. Limitations, reasons for caution In this study, women with VIUPs presented with pain and/or bleeding. The presence of symptoms may influence the metabolome of this group versus VIUPs without symptoms, thus limiting the translation of our findings. Furthermore, environmental factors were not controlled (e.g. fasting status), making it likely that cohort heterogeneity was enhanced. Wider implications of the findings This study identifies a metabolite profile associated with VIUPs. These findings may be useful in the development of a diagnostic test to confirm VIUPs and thus exclude potentially life-threatening pregnancy outcomes. Such a test would be invaluable in clinical emergencies. Trial registration number NA

scholarly journals Provisionally pregnant: uncertainty and interpretive work in accounts of home pregnancy testing

2017 ◽  
Vol 22 (1) ◽  
pp. 87-105 ◽  
Author(s):  
Emily Ross
Keyword(s):  
Positive Result ◽  
Early Pregnancy ◽  
Reproductive Rights ◽  
First Trimester ◽  
Pregnancy Test ◽  
Early Gestation ◽  
Medical Technologies ◽  
The United Kingdom ◽  
Pregnancy Testing ◽  
First Trimester Of Pregnancy

Upon their availability for purchase in the 1970s, home pregnancy testing devices were hailed as a ‘revolution’ for women’s reproductive rights. Some authors, however, have described these technologies as further enabling the medicalisation of pregnancy and as contributing to the devaluing of women’s embodied knowledge. The home pregnancy test is one of many technological devices encountered by women experiencing pregnancy in the United Kingdom today. Existing literature has described how engagement with medical technologies during pregnancy might address uncertainties experienced at this time, providing women with reassurance and alleviating anxieties. Drawing on interviews with women living in Scotland, this article explores accounts of testing for a first pregnancy, and women’s descriptions of the impacts of home pregnancy testing upon experiences of early gestation. Participants engaged with pregnancy tests in varying ways, with uses shaping and shaped by their experiences of early pregnancy more broadly. Particular technical characteristics of the home pregnancy test led many participants to question their interpretation of a positive result, as well as the accuracy of the test itself. Rather than addressing the unknowns of early gestation by confirming a suspected pregnancy, a positive result could thus exacerbate uncertainty. Through participants’ accounts, this article shows how uncertainty is lived out by users of mundane techno-medical artefacts and sheds new light on women’s experiences of the first trimester of pregnancy.

Detection of the Small-for-Gestational Age Twin Fetus by a Two-Stage Ultrasound Examination Schedule

1982 ◽  
Vol 31 (3-4) ◽  
pp. 235-240 ◽  
Author(s):  
J.P. Neilson
Keyword(s):  
Early Pregnancy ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Ultrasound Examination ◽  
Ultrasonic Measurement ◽  
Two Stage ◽  
Crown Rump Length ◽  
Biparietal Diameter ◽  
Ultrasonic Assessment ◽  
Twin Pregnancies

Serial ultrasonic measurement of the biparietal diameter is an unsatisfactory means of detecting the small-for-gestational age (SGA) fetus in twin pregnancies. A new two-stage ultrasound examination schedule, highly effective in detecting the SGA singleton fetus, has been evaluated prospectively in 31 twin pregnancies. The schedule comprises ultrasonic assessment of gestational age in early pregnancy, followed by measurement of the product of the crown–rump length and trunk area of both fetuses at 34–36 weeks. All Nineteen SGA twin fetuses were detected using this schedule; the technique offers several other advantages over serial biparietal cephalometry.

The events of early pregnancy: prying open the black box

2012 ◽  
Vol 40 (6) ◽  
pp. 617-618 ◽  
Author(s):  
A. M. Jukic ◽  
A. J. Wilcox
Keyword(s):  
Early Pregnancy ◽  
Black Box
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