Yolk sac size and embryonic heart rate as prognostic factors of first trimester pregnancy outcome.

OBJECTIVES: To investigate embryonic heart rate (EHR) and yolk sac diameter (YSD) during the first trimester and their role as prognostic markers of first trimester pregnancy outcome. STUDY DESIGN: Prospective cohort study involving 219 women conducted in the 4th Academic Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece. Gestational age (GA) was determined ultrasonographically based on gestational sac diameter and crown-rump length. EHR and YSD were evaluated during the first 12 weeks and subsequently compared between the pregnancies that continued beyond the first trimester and those that resulted in spontaneous abortion. Receiver-operating characteristic (ROC) curves were used for the evaluation of the prognostic value of the combination of gestational age with embryonic heart rate and yolk sac diameter. RESULTS: The EHR and YSD were significantly correlated to advancing gestational age (p<0.001) in pregnancies continuing beyond 12 weeks. Pregnancies that resulted in spontaneous abortion exhibited a statistically significant lower EHR (p<0.001), smaller YSD (p=0.001) or absent yolk sac. ROC curve analysis demonstrated the predictive value of the combination of GA with EHR (area under the ROC curve: 0.971, p<0.001) and GA with YSD (area under the ROC curve: 0.858, p<0.001) for first trimester pregnancy outcome. CONCLUSIONS: EHR and YSD progressively increase in healthy pregnancies during the first trimester. Embryonic bradycardia and absence of yolk sac or even a smaller yolk sac diameter than expected for any gestational age are predictors of poor pregnancy outcome during the first 12 weeks.

The effect of anastrazole on symptomatic uterine leiomyomata.

OBJECTIVE: To evaluate the effect of anastrazole on symptomatic uterine leiomyomata. METHODS: This was a prospective intervention study carried out in a university department of obstetrics and gynecology. Forty-one premenopausal women eligible for hysterectomy with 45 uterine leiomyomata were enrolled and treated with anastrazole 1 mg daily for three cycles of 28 days each. The effect of treatment was evaluated on leiomyoma and uterine volumes, endometrial thickness, gonadotrophins, estradiol and hematocrit levels, menstrual pattern, severity of leiomyoma-related symptoms, and adverse effects. The effects of leiomyoma location, size, and age of participants on tumor volume changes were evaluated. RESULTS: Thirty-five women with 39 leiomyomata finished the study. Anastrazole resulted in a mean 55.7% reduction of leiomyoma volumes (163 mL to 72 mL, P<.001), a 29.9% reduction in total uterine volumes (278 mL to 195 mL, P<.001), and an 11.3% increase of the hematocrit levels (33.4% to 37.2%, P<.001) at the end of the treatment. Leiomyoma location had no significant effect on volume decrease. Leiomyoma volume decreased in women aged older than 40 years (P=.002), whereas no difference was found in women younger than 40. The size of large (greater than 50 mm) leiomyomata decreased significantly (P=.004). Less difference was observed in small (50 mm or less) leiomyomata (P=.031). No differences were detected in hormonal status. Anastrazole improved leiomyoma-related symptomatology and caused no serious adverse effects. CONCLUSION: In premenopausal women, anastrazole reduces the size of uterine leiomyomata, improves symptomatology, and is generally well tolerated. LEVEL OF EVIDENCE: III.