Effect of abnormal yolk sac, gestational sac and embryonic heart rate in pregnancy outcome

Authors

  • Jyoti Jaiswal Department of Obstetrics and Gynecology, Pt. JNM Medical College and Dr Bhim Rao Ambedkar Memorial Hospital Raipur, Chhattisgarh, India
  • Anand Kumar Jaiswal Department of Radiodiagnosis, Pt. JNM Medical College and Dr Bhim Rao Ambedkar Memorial Hospital Raipur, Chhattisgarh, India
  • Geetanjali Patel Department of Obstetrics and Gynecology, Pt. JNM Medical College and Dr Bhim Rao Ambedkar Memorial Hospital Raipur, Chhattisgarh, India
  • Abha Daharwal Department of Obstetrics and Gynecology, Pt. JNM Medical College and Dr Bhim Rao Ambedkar Memorial Hospital Raipur, Chhattisgarh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20212814

Keywords:

YSD, Gestational sac diameter, Embryonic heart rate, Transvaginal ultrasonography

Abstract

Background: The purpose of the study is to know the effect of abnormal yolk sac, abnormal gestational sac and abnormal embryonic heart rate on outcome of pregnancy in the tertiary care centre of Chhattisgarh.

Methods: This prospective observational study included 50 pregnant females between 6-9 weeks gestation with singleton pregnancy attending antenatal clinic in a tertiary medical institution. Transvaginal sonography was carried out to quantify yolk sac characteristics. Abnormal yolk sac was defined according to Nyberg criteria.

Results: Out of 50 cases, 25 cases had abnormal yolk sac, 23 cases had abnormal gestational sac and 22 cases had abnormal embryonic heart rate and heart rate was absent in 23 cases. Out of 50 cases, 32 got aborted and rest 18 cases had ongoing pregnancy beyond 20 weeks. Normal yolk sac diameter (YSD) (2-5 mm) showed 72.2% sensitivity, 62.5% specificity, 52% positive predictive value and 80% negative predictive value in predicting pregnancy outcome. Gestational sac diameter had 66.66% sensitivity, 53.12% specificity, 44.44% PPV and 73.91% NPV and for EHR had 22.22% sensitivity, 96.87% specificity, 80% PPV and 68.88% NPV.

Conclusions: The embryos with abnormal YSD are highly associated with poor pregnancy outcome with good sensitivity and NPV. Present study indicates that the yolk sac measurement is reliable prognostic factor in predicting 1st trimester pregnancy outcome.

Author Biography

Geetanjali Patel, Department of Obstetrics and Gynecology, Pt. JNM Medical College and Dr Bhim Rao Ambedkar Memorial Hospital Raipur, Chhattisgarh, India

post graduate resident, Dept of Obstetrics and Gynaecology, Pt JNM Medical College and associated Dr. BRAMH, Raipur

References

Celen S, Dover N, Seckin B, Goker U, Yenicesu O, Danisman N. Utility of First Trimester Ultrasonography before 11 Weeks of Gestation: a retrospective Study. Obstet and Gynecol. 2012;2012:6.

Morin L, Hof V. Ultrasound evaluation of first trimester pregnancy complications. J Obstet and Gynaecol. 2005;27(6):581-91.

Adiga P, Selvi C, Rai L, Hebbar S. Evaluation of yolk sac diameter and embryonic heart rate as prognostic factors of gestational outcome in early singleton pregnancies. Sch J App Med Sci. 2015;3(2A):543-50.

Goldstein SR. Early detection of pathologic pregnancy by transvaginal sonography. J Clin Ultrasound. 1990 May;18(4):262-73.

Timor-Tritsch IE, Farine D, Rosen MG. A close look at early embryonic developmentwith the high-frequency transvaginal transducer. Am J ObstetGynecol. 1988;159(3):676-81.

Makikallio K, Tekay A, Jouppila P. Yolk sac and umbilico-placental hemo-dynamics during early human embryonic development. Ultrasound Obstet Gynecol. 1999;14(3):175-9.

Levi CS, Dashefsky SM, Lyons EA, Holt CS, Lindsay DJ. First-trimester ultrasound. In: McGahan JP, Goldberg BB, editors. Diagnostic Ultrasound: A Logical Approach. 1st ed. Philadelphia, PA: Lippincott-Raven. 1997:134-48.

Srivastava G, Nagwani M, Pasricha N, Tewari V, Siddiqui M, Sthapak E. Sizeof yolk sac by ultrasonography and its correlation with pregnancy outcome. Int J Anat Res. 2016;4(1):2052-7.

Nyberg DA, Laing FC, Filly RA. Threatened abortion: sonographic distinction of normal and abnormal gestation sacs. Radiology. 1986;158(2):397-400.

Manchanda P, Birla N, Dharamdasani M, Shetty N. Correlation of yolk sac diameter on TVS with fetal outcome. Int J Sci Res. 2016;5(4):1022-4.

Makrydimas G, Sebire NJ, Lolis D, Vlassis N, Nicolaides KH. Fetal loss following ultrasound diagnosis of a live fetus at 6-10 weeks of gestation. Ultrasound Obstet Gynaecol. 2003;22(4):368-72.

Bae S, Karnitis J. Triple ultrasound markers including fetal cardiac activity are related to miscarriage risk. Fertil Steril. 2011;96(5):1145-8.

Kucuk T, Duru NK, Yenen MC, Dede M, Ergun A, Baser I. Yolk sac size and shape as predictors of poor pregnancy outcome. J Perinat Med. 1999;27(4):316-20.

Moradan S, Forouzeshfar M. Are Abnormal Yolk Sac Characteristics Important Factors in Abortion Rates? Int J Fertil Steril. 2012;6(2):127-30.

Tan S, İpek A, Pektas MK, Arifoğlu M, Teber MA, Karaoğlanoğlu M. Irregular Yolk Sac Shape. J Ultrasound Med. 2011;30(1):31-6.

Bromley B, Harlow BL, Laboda LA, Benacerraf BR. Small sac size in the first trimester: a predictor of poor fetal outcome. Radiology. 1991;178(2):375-7.

Falco P, Zagonari S, Gabrielli S, Bevini M, Pilu G, Bovicelli L. Sonography of pregnancies with first-trimester bleeding and a small intrauterine gestational sac without a demonstrable embryo. Ultrasound Obstet Gynecol. 2003;21(1):62-5.

OhJ S, Wright G, Coulam CB. Gestational sac diameter in very early pregnancy as a predictor of fetal outcome. Ultrasound Obstet Gynecol. 2002;20(3):267-9.

Shenker L, Astke C, Reed K, Anderson C. Embryonic heart rates before the seventh week of pregnancy. J Reprod Med. 1986;31(5):333-5.

Laboda LA, Eastroff JA, Benacerraf BR. First trimester bradycardia: A sign of impending foetal loss. J Ultrasound Med. 1989;8(10):561-3.

Benson CB, Doubilet PM. Slow embryonic heart rate in early first trimester: indicator of poor pregnancy outcome. Radiology. 1994;192(2):343-4.

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Published

2021-07-26

Issue

Vol. 10 No. 8 (2021): August 2021

Section

Original Research Articles