Amniotic sac reference interval in early pregnancy between 7 and 10 weeks' gestation.

OBJECTIVE: To establish a normal reference interval for amniotic sac measurements between 7 and 10 weeks of gestation and its relative size in relation to the gestational sac and the embryo. METHOD: This was a prospective, cross-sectional study of consecutive women presenting to UCLH Early Pregnancy Unit between August 2022 to June 2023. We included live, normally sited, singleton pregnancies with a normal 20-week anomaly scan. We collected 120 cases per gestational week totaling 360 cases. We performed an inter and intra-observer variability assessment in the measurement of mean ASD in 30 patients. Regression analyses were used to establish reference intervals for GSD to CRL, ASD to CRL, GSD to ASD and GSD:ASD ratio to CRL. The fitted regression line was calculated, along with a 90% prediction interval and the R2 value. RESULTS: There was good interobserver agreement (difference 0.007mm ± 1.105 (95%CI -2.160 to 2.174)) and good intra-observer agreement between Observer A (0.007 ± 1.105 (-2.160 to 2.174)) and Observer B (-0.014 ± 0.919 (-1.814 to 1.786)) in the measurement of mean ASD in 30 patients. Regression analyses showed a highly statistically significant association between each pair of values (all p-values <0.001). There were significant quadratic associations between mean GSD and CRL (R2 = 56%) and mean GSD and ASD (R2 = 60), significant cubic association between ASD and CRL (R2 = 90%) and significant quadratic association between GSD to ASD ratio and CRL (R2 = 68%). The regression equations were used to quantify the values of ASD and GSD to ASD ratios for a range of CRL values and gestational age in days. CONCLUSION: Our study has produced comprehensive reference intervals for amniotic sac size in early pregnancy which could be used in routine clinical practice. This article is protected by copyright. All rights reserved.

Ovarian ectopic pregnancy: clinical characteristics, ultrasound diagnosis and management.

OBJECTIVE: To compare clinical, ultrasound and biochemical characteristics of ovarian ectopic pregnancies (OEP) to tubal ectopic pregnancies (TEP). METHODS: This was a single-center, retrospective, case-control study of women with OEP compared to women with TEP between December 2010 and February 2021. OEP was defined as a pregnancy located completely or partially within the ovarian parenchyma, seen separately to a corpus luteum, where a corpus luteum was within the ipsilateral ovary. We compared demographic features, risk factors, clinical presentation, ultrasound findings and outcomes such as blood loss at surgery, blood transfusion rate, length of hospital stay, follow-up and future pregnancy outcomes of women who conceived. RESULTS: 20 women with OEP were identified and compared to 100 women with TEP. 15/20 (75%) OEPs were diagnosed correctly on the first scan. There was no difference between the groups in terms of maternal age, gestational age, gravidity, parity or risk factors. Compared to TEPs, OEPs were more likely to present with abdominal pain without vaginal bleeding (12/20 (60%) vs 13/100 (13%) (p=<0.01) (OR 10; 95%CI 3.45-29.20)), were more likely to contain an embryo (3/20 (15%) vs 2/100 (2%) (p=0.02) (OR 8.7; 95%CI 1.34-55.65)), have severe hemoperitoneum on ultrasound scan (9/20 (45%) vs 8/100 (8%) (p=<0.01) (OR 9.4; 95%CI 3.01-29.40)) and had higher blood loss at surgery (median 700ml vs 100ml, p=<0.01). All surgically managed OEPs had successful laparoscopic treatment (18 excisions, 1 wedge resection) with preservation of the ovary. Only 1/20 (5%) OEPs required a blood transfusion. CONCLUSIONS: OEPs are more likely than TEPs to contain an embryo and to present with severe hemoperitoneum. In a dedicated early pregnancy setting the majority of OEPs could be detected on ultrasound scan at the initial visit, facilitating optimal minimally invasive surgical management, reducing the risk of blood transfusions and oophorectomy. Our findings can be used as a reference for clinicians who may not otherwise encounter this rare condition. This article is protected by copyright. All rights reserved.

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies.

STUDY QUESTION: What is the risk of loss of a live normally sited (eutopic) pregnancy following surgical treatment of the concomitant extrauterine ectopic pregnancy? SUMMARY ANSWER: In women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine ectopic pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. WHAT IS KNOWN ALREADY: Previous studies have indicated that surgical treatment of the concomitant ectopic pregnancy in women with live eutopic pregnancies could be associated with an increased risk of miscarriage. The findings of our study did not confirm that. STUDY DESIGN SIZE DURATION: A retrospective observational case-control study of 52 women diagnosed with live eutopic and concomitant extrauterine pregnancies matched to 156 women with live normally sited singleton pregnancies. The study was carried out in three London early pregnancy units (EPUs) covering a 20-year period between April 2000 and November 2019. PARTICIPANTS/MATERIALS SETTING METHODS: All women attended EPUs because of suspected early pregnancy complications. The diagnosis of heterotopic pregnancy was made on ultrasound scan and women were subsequently offered surgical or expectant management.There were three controls per each case who were randomly selected from our clinical database and were matched for maternal age, mode of conception and gestational age at presentation. MAIN RESULTS AND THE ROLE OF CHANCE: In the study group 49/52 (94%) women had surgery and 3/52 (6%) were managed expectantly. There were 9/52 (17%, 95% CI 8.2-30.3) miscarriages <12 weeks' gestation and 9/49 (18%, 95% CI 8.7-32) miscarriages in those treated surgically. In the control group, there were 28/156 (18%, 95% CI 12.2-24.8) miscarriages <12 weeks' gestation, which was not significantly different from heterotopic pregnancies who were treated surgically [odds ratio (OR) 1.03 95% CI 0.44-2.36]. There was a further second trimester miscarriage in the study group and one in the control group. The live birth rate in the study group was 41/51 (80%, 95% CI 66.9-90.2) and 38/48 (79%, 95% CI 65-89.5) for those who were treated surgically. These results were similar to 127/156 (81%, 95% CI 74.4-87.2) live births in the control group (OR 0.87, 95% CI 0.39-1.94). LIMITATIONS REASONS FOR CAUTION: This study is retrospective, and the number of patients is relatively small, which reflects the rarity of heterotopic pregnancies. Heterotopic pregnancies without a known outcome were excluded from analysis. WIDER IMPLICATIONS OF THE FINDINGS: This study demonstrates that in women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. This finding will be helpful to women and their clinicians when discussing the options for treating heterotopic pregnancies. STUDY FUNDING/COMPETING INTERESTS: This work did not receive any funding. None of the authors has any conflict of interest to declare. TRIAL REGISTRATION NUMBER: Research Registry: researchregistry6430.