Miscarriage and early first trimester growth restriction by ultrasound


  • Neelima Agarwal Department of Obstetrics and Gynaecology, Santosh Medical College and Hospital, Santosh University, Ghaziabad, Uttar Pradesh, India
  • Amita Sharma Department of Obstetrics and Gynaecology, Santosh Medical College and Hospital, Santosh University, Ghaziabad, Uttar Pradesh, India




Early pregnancy, Growth restriction, Miscarriage, Ultrasound


Background: Concern about the possibility of spontaneous miscarriage is one of the most common reasons women seek evaluation in the emergency department during their first trimester. According to the obstetrics and gynecology literature, it is estimated that 20% to 25% of all clinically recognized pregnancies result in spontaneous miscarriage. The objective of the study is to examine with whether viable early pregnancies that subsequently end in miscarriage exhibit evidence of first-trimester growth restriction. The prospective cohort study design used for this purpose with setting of Antenatal clinic of a teaching hospital. Women attending the clinic between 5 and 10 weeks of gestation took part in the study.

Methods: Women with spontaneously conceived intrauterine, viable singleton pregnancies with certain last menstrual period and regular cycles were included. The deviation between the observed and expected crown-rump length (CRL) for gestation was calculated and expressed as a z-score. Pregnancies were followed up until 11-14 weeks, and the deviation between those that remained viable and miscarried subsequently was calculated. Viability at 11-14 weeks was measured.

Results: Over 12 months, 320 women met the inclusion criteria. Twenty women were excluded. Of the remaining 300, the pregnancy remained viable in 248 (82.6%) and 52 (17.4%) suffered a miscarriage. At the first transvaginal ultrasound, the z score of the mean measured CRL for pregnancies that remained viable was -0.69 while in pregnancies that subsequently miscarried the z-score was -2.95 and the CRL was significantly smaller (P < 0.048). In the latter group, the initial CRL was below the expected mean for gestational age in all women.

Conclusions: CRL was significantly smaller in pregnancies that subsequently ended in miscarriage. This suggests that early first trimester growth restriction is associated with subsequent intrauterine death.


Zinaman MJ, Clegg ED, Brown CC, O'Connor J, Selevan SG. Estimates of human fertility and pregnancy loss. Fertil Steril. 1996;65:503-9.

Jauniaux E, Johns J, Burton GJ. The role of ultrasound imaging in diagnosing and investigating early pregnancy failure. Ultrasound Obstet Gynecol. 2005;25:613-24.

Reljic M. The significance of crown-rump length measurement for predicting adverse pregnancy outcome of threatened abortion. Ultrasound Obstet Gynecol. 2004;17:510-2.

Goldstein SR, Kerenyi T, Scher J, Papp C. Correlation between karyotype and ultrasound findings in patients with failed early pregnancy. Ultrasound Obstet Gynecol. 1996;8:314-7.

Savitz DA, Terry JW, Dole N, Thorp JM, Siega-Riz AM, Herring AH. Comparison of pregnancy dating by last menstrual period, ultrasound scanning and their combination. AmJ Obstet Gynecol. 2002;187:1660-6.

Bottomley C, Daemen A, Mukri F, Papageorghiou AT, Kirk E, Pexsters A, et al. Assessing first trimester growth: the influence of ethnic background and maternal age. Hum Reprod. 2009;24(2):284-90.

Mukri F, Bourne T, Bottomley C, Schoeb C, Kirk E, Papageorghiouet AT. Evidence of early first trimester growth restriction in pregnancies that subsequently end in miscarriage. BJOG. 2008;115:1273-8.

Papaioannou GI, Syngelaki A, Poon LCY, Ross JA, Nicolaides KH. Normal ranges of embryonic length, embryonic heart rate, gestational sac diameter and yolk sac diameter at 6-10 weeks. Fetal Diagn Ther. 2010;28:207-19.

Abuelghar WM, Fathi HM, Ellaithy MI, Anwar MA. Can a smaller than expected crown-rump lengths reliably predict the occurrence of subsequent miscarriage in a viable first trimester pregnancy? J Obstet Gynaecol Res. 2013;39(10):1449-55.

D'Antonio F, Khalil A, Mantovani E, Thilaganathan B. Southwest Thames Obstetric Research Collaborative. Embryonic growth discordance and early fetal loss: the STORK multiple pregnancy cohort and systematic review. Hum Reprod. 2013;28(10):2621-7.

Wie JH, Choe S, Kim SJ, Shin JC, Kwon JY, Park IY. Sonographic parameters for prediction of miscarriage: role of 3-dimensional volume measurement. J Ultrasound Med. 2015;34(10):1777-84.






Original Research Articles