Viable early pregnancies that end in miscarriage often show evidence of first-trimester growth restriction as indicated by a smaller than expected crown-rump length (CRL), new study findings suggest.
Researchers from centers in London, UK, and Leuven, Belgium, performed a prospective cohort study of 292 women who attended a teaching hospital?s early pregnancy unit at between 5 and 10 weeks? gestation and who had a transvaginal ultrasound scan. The pregnancies were followed up until the routine ultrasound assessment at 11-14 weeks.
All of the pregnancies were spontaneously conceived and singletons, and all of the women previously had regular cycles and had a certain date for the last menstrual period, allowing accurate dating of gestational age.
Of the 292 pregnancies, 86 percent remained viable at 11-14 weeks, and 14 percent had a miscarriage between the initial presentation and the 11-14 week scan. There were no significant differences between the two groups in maternal characteristics, parity or obstetric history.
However, the researchers found that the observed CRL at the initial ultrasound examination was smaller than expected (based on established growth curves of gestational age and CRL) in the pregnancies that subsequently ended in miscarriage.
The initial CRL was below the expected mean for gestational age in all 41 of the pregnancies that miscarried, and was at least two standard deviations below the expected mean in 25 of the 41 pregnancies (61 percent).
Writing in their paper in the current issue of the
BJOG: An International Journal of Obstetrics and Gynaecology, the researchers conclude that they have demonstrated that in women with spontaneously conceived singleton pregnancies and certain menstrual dates, the CRL is below that expected for gestational age ?in all cases that will subsequently miscarry, and is at least two standard deviations below that expected in almost two-thirds of women.?
A co-author of the new paper, Dr Faizah Mukri from St George?s Healthcare NHS Trust in London, suggested that healthcare professionals consider offering women with a small CRL a further ultrasound before their routine scan (in the UK) at around 12 weeks, to confirm that the pregnancy has not failed: ?Although performing such a repeat examination is unlikely to affect the ultimate outcome of the pregnancy, recognition that a smaller than expected CRL is a marker of possible impending miscarriage may help in counseling and reduce the number of women who are found to have unrecognized failed pregnancies at the time of the 12-week scan, with its associated psychological impact.?
Professor Philip Steer, editor-in-chief of the
BJOG, added: ?This research has shown that a small CRL can indicate that a miscarriage is likely to occur in future, and more of this kind of research should be undertaken to test the validity of the hypothesis. If the findings of this study are confirmed, healthcare professionals will be in a better position to prepare the mother for the worst and to support her during this difficult time.?
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Miscarriage marker identified
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