Prediction of early pregnancy failure by use of first trimester ultrasound screening

Snigdha Kumari, Joydeb Roychowdhury, Supratim Biswas


Background: Spontaneous miscarriage is defined as an involuntary termination of pregnancy before 20th week of gestation or spontaneous expulsion of fetus below a fetal weight of 500 gm. The introduction of ultrasound into the obstetrical practice has been extremely useful in providing better understanding of the etiology of the first trimester spontaneous abortion and a basis for its clinical classification and management. The aims and objective of this study is to assess the early pregnancy developmental changes in first trimester ultrasound screening, identify abnormal ultrasound parameters and correlate the ultrasonic findings with the clinical outcomes and also to analyze the success of conservative management on patients.

Methods: The study included 150 patients attending OPD/emergency within 5-12 weeks of gestation fulfilling the exclusion and inclusion criteria.

Results: The abortion rate in our study was 16%. Seventy two percent of abortion occurred at 8-12 weeks of gestation. Threatened abortion was noted in 10% of the patients. Sixteen percent of patients had abnormal USG findings in terms of large yolk sac, abnormal mean sac diameter, crown rump length, embryonic bradycardia, increased resistive index and intrauterine hematoma.

Conclusions: This study emphasizes the role of ultrasound in prediction of early pregnancy failure in first trimester. It also stresses on the importance of learning obstetric ultrasound and performing obstetric practice in the community with precision and perfection.


Early pregnancy failure, Spontaneous abortion, First trimester ultrasonographic screening

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Speroff L, Fritz MA. Recurrent early losses. Clinical gynecological endocrinology and infertility.7th edition. Philadelphia: Lippincott Williams and Wilkins; 2005:1069.

Jurkovic D, Overton C, Bender AR. Diagnosis and management of first trimester miscarriage. British Med J. 2013;346:3676.

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.

Laing, Faye C, Frates MC, Benson CB. Ultrasound evaluation during the first trimester of pregnancy. In: Ultrasonography in Obstetrics and Gynecology. 4th edition. Philadelphia, PA: WB Saunders Co;2000:105-145.

Crespigny D, Lachlan C, Cooper D, McKenna M. Early detection of intrauterine pregnancy with ultrasound. J Ultrasound Med. 1988;7(1):7-10.

Tuladhar AS, Tuladhar AG, Karki DB, Shrestha A, Pradhan S. Role of ultrasound in early pregnancy in differentiating normal and abnormal pregnancies. Nepal Med Coll J. 2009;11(2):127-9.

Hansmann M, Hackrloer BJ, Staudach A, Wittonan BK, Telger TC. Introduction. Ultrasound Diagnosis in Obstetrics and Gynecology. 1st edition. New York: Springer Verlag;1985:241-66.

Zinaman MJ, Clegg ED, Brown CC, Connor JO, Selevan SG. Estimates of human fertility and pregnancy loss. Fertil Steril. 1996;65(3):503-9.

Rai R, Regan L. Recurrent miscarriage. Lancet. 2006;368:601-11.

Brigham S, Conlon C, Farquharson RG. A longitudinal study of pregnancy outcome following idiopathic recurring miscarriage. Hum Reprod. 1999;14:2868-71.

Ugwumadu A, Manyonda I, Reid F, Hay P. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis; a randomized controlled trial. Lancet. 2003;361:983-8.

Buss L, Tolstrup J, Munk C, Bergholt T, Ottesen B, Gronbaek M, Kjaer SK. Spontaneous abortion: a prospective cohort study of younger women from the general population in Denmark. Validation, occurrence and risk determinants. Acta Obstet Gynecol Scand. 2006;85(4):467-75.

Bisset RA. Differential diagnosis in obstetrics and gynecologic ultrasound. Elsevier Health Sciences; 2013 Nov 28.

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;27:316-20.

Pennell RG, Needelman L, Pajak T. Prospective comparison of vaginal and abdominal sonography in normal early pregnancy. J Ultasound Med. 1991;10:63-7.

Levi CS, Lyons EA, Zheng XH. Transvaginal US: Demonstration of cardiac activity in embryos less than 5.0 mm in crown-rump length. Radiology. 1990;176:71-4.

Tezuka N, Sato S, Kanasugi H, Hiroi M. Embryonic heart rates: development in early first trimester and clinical evaluation. Gynecol Obstet Invest. 1991;32:210-2.

Chittacharoen A, Herabutya Y. Slow fetal heart rate may predict pregnancy outcome I first trimester threatened abortion. Fertil Steril. 2004;82:227-9.

Sprock VZ, Vugt MM, Colenbrander JMG, Geijn HP. First-trimester uteroplacental and fetal blood flow velocity waveforms in normally developing fetuses: a longitudinal study. Ultrasound Obstet Gynecol. 1994:4;284-8.

Nuaim LA, Chowdhury N, Adelusi B. Subchorionic hematoma in threatened abortion: sonographic evaluation and significance. Ann Saudi Med. 1996;16(6):650-3.