Reference intervals of gestational sac, yolk sac, embryonic length, embryonic heart rate at 6-10 weeks after in vitro fertilization-embryo transfer.

BACKGROUND: Accurately determining the normal range of early pregnancy markers can help to predict adverse pregnancy outcomes. The variance in ovulation days leads to uncertain accuracy of reference intervals for natural pregnancies. While the gestational age (GA) is accurate estimation during in vitro fertilization-embryo transfer (IVF-ET). Thus, the objective of this research is to construct reference intervals for gestational sac diameter (GSD), yolk sac diameter (YSD), embryonic length (or crown-rump length, CRL) and embryonic heart rate (HR) at 6-10 gestational weeks (GW) after IVF-ET. METHODS: From January 2010 to December 2016, 30,416 eligible singleton pregnancies were retrospectively recruited. All included participants had full records of early ultrasound measurements and phenotypically normal live neonates after 37 GW, with birth weights > the 5th percentile for gestational age. The curve-fitting method was used to screen the optimal models to predict GSD, CRL, YSD and HR based on gestational days (GD) and GW. Additionally, the percentile method was used to calculate the 5th, 50th, and 95th percentiles. RESULTS: There were significant associations among GSD, CRL, YSD, HR and GD and GW, the models were GSD = - 29.180 + 1.070 GD (coefficient of determination [R2] = 0.796), CRL = - 11.960 - 0.147 GD + 0.011 GD2 (R2 = 0.976), YSD = - 2.304 + 0.184 GD - 0.011 GD2 (R2 = 0.500), HR = - 350.410 + 15.398 GD - 0.112 GD2 (R2 = 0.911); and GSD = - 29.180 + 7.492 GW (R2 = 0.796), CRL = - 11.960 - 1.028 GW + 0.535 GW2 (R2 = 0.976), YSD = - 2.304 + 1.288 GW - 0.054 GW2 (R2 = 0.500), HR = - 350.410 + 107.788 GW - 5.488 GW2 (R2 = 0.911), (p < 0.001). CONCLUSIONS: Reference intervals for GSD, YSD, HR and CRL at 6-10 gestational weeks after IVF-ET were established.

Prediction of abortion using three-dimensional ultrasound volumetry of the gestational sac and the amniotic sac in threatened abortion.

PURPOSE: To determine whether gestational sac volume (GSV) or amniotic sac volume (ASV) and/or the difference between them can predict abortion in women with first-trimester threatened abortion. METHODS: Ninety patients between 6 and 12 weeks of gestation presenting with vaginal bleeding were studied. Seventy-six delivered after 24 weeks of gestation (group A) and 14 aborted before 20 weeks of gestation (group B). All patients had a singleton viable pregnancy demonstrated by transvaginal ultrasound. Gestational sac and amniotic sac volumes were measured in all the patients using three-dimensional transvaginal ultrasound with Virtual Organ Computer-aided Analysis software, and the gestational sac volume - amniotic sac volume (GSV - ASV) was calculated. RESULTS: The groups did not differ in terms of age, parity, number of previous abortions, or term deliveries. The GSV (group A: mean 32.0 ± 27.7 cm(3) ; group B: 26.7 ± 29.1 cm(3) ) and the ASV (group A: 21.1 ± 25.5 cm(3) ; group B: 20.6 ± 26.0 cm(3) ) were not statistically different, while the GSV - ASV was significantly smaller in group B (aborting before week 20) (group A: 10.9 ± 10.9 cm(3) ; group B: 6.1 ± 8.6 cm(3) ; p < 0.05). Using receiver operator curves, the area under the curve for predicting normal pregnancy outcome of the GSV - ASV measurement was 0.654. When the GSV - ASV was 1.8 cm(3) or less, abortion was predicted with 84% sensitivity and 43% specificity. CONCLUSIONS: The measurement of the GSV and the ASV are not good predictors of abortion in patients with first-trimester vaginal bleeding, whereas the use of the GSV - ASV may be helpful in predicting the outcome of pregnancy.

Prediction of outcome in dichorionic twin pregnancies at 6-10 weeks' gestation.

OBJECTIVE: The objective of the study was to predict the outcome of dichorionic (DC) twin pregnancies at 6-10 weeks' gestation from intertwin discordance in crown-rump length (CRL), heart rate (HR), and gestational sac diameter (GSD). STUDY DESIGN: Intertwin discordance in CRL, HR, and GSD, was compared in 3 groups of DC twin pregnancies with 2 live embryos at 6-10 weeks. In one group, there were 2 live births (n = 174), in another 1 live birth (n = 24), and in a third group there were no live births (n = 33). Regression analysis was used to determine the predictors of outcome. RESULTS: Significant contributors to the prediction of 1 intrauterine death were discordance in CRL and GSD. The only predictor of 2 deaths was discordance in CRL. Detection rates of screening for single or double death, at 10% false-positive rate, were 79.2% and 27.3%, respectively. CONCLUSION: In DC twins, intertwin discordance in CRL and GSD at 6-10 weeks can predict outcome.

How Does Tobacco Smoke Affect Fetal Growth Potential in the First Trimester of Pregnancy as Measured by Volume Parameters of the Fetus, Trophoblast, and Gestational Sac?

We aimed to assess if tobacco smoke, as measured by the serum concentration of cotinine and blood concentration of cadmium, influences the fetal, sac, and trophoblast volume in the first trimester of pregnancy. We enrolled women in weeks 11 to 14 of pregnancy: 35 smokers, 24 passive smokers, and 98 nonsmoking healthy women. We found that the fetus volume was similar in all groups (18.70 ± 6.29, 17.11 ± 5.4, 18.97 ± 7.55 cm3). The trophoblast was significantly smallest in smokers (50.27 ± 19.56, 56.71 ± 23.50, 61.95 ± 22.94 cm3). The trophoblast volume was correlated with cotinine and cadmium concentration ( r = -0.54, r = -0.44). In passive smokers, gestational sac and trophoblast volume grew systematically and were correlated with the mean parental height. In smokers, only the gestational sac grew systematically and was correlated with the mean parental height. The fetus volume was independent of mean parental height and intensity of exposure to tobacco smoke. Volumetric changes of the fetus, trophoblast, and sac may be observed in the first trimester; however, their consequences require further research.

Pregnancy in Hystricomorpha: gestational age and embryonic-fetal development of agouti (Dasyprocta prymnolopha, Wagler 1831) estimated by ultrasonography.

Thirty-one pregnant agoutis, between Days 9 and 103 of gestation (Day 1 = day of detection of sperm in the vaginal smear), underwent B-mode ultrasonography; gestational sac diameter (GSD), crown-rump length (CRL), embryonic-fetal diameter (EFD), and placenta diameter (PD) were measured. There were positive correlations (P < 0.05) between GSD and CRL (r = 0.98), GSD and PD (r = 0.88), CRL and PD (r = 0.86), days of gestation (DG) and CRL (r = 0.85), and DG and PD (r = 0.73). The gestational sac was first observed on Day 14. The embryo was first seen on Day 18 in 9/31 of pregnant agoutis and on Day 22 in 20/31 of pregnant agoutis. Heartbeats were detected from the Day 25 and placentas were observed in 100% of the animals from Day 25. Early limb bud and ossification of the fetal skull were identified on Days 27 (15/31) and 45 (24/31), respectively. Fetal orientation (head and body) was evident from Day 40, the stomach, liver and lungs were identified on Day 50, the kidneys were reliably seen only on Day 55, and the aorta and vena cava were seen on Day 70. The fetal bowel and the urinary bladder were the last structures to be observed (Day 85). Ultrasonography was effective for early pregnancy diagnosis in agouti and for obtaining information on embryonic and fetal structures that could be used to predict gestational age and birth, thereby contributing to their reproductive management in captivity.

Sonographic markers of aneuploidies at 6-10 weeks of gestation.

OBJECTIVES: To determine if sonographic features of live embryos at 6-10 weeks' gestation are altered in aneuploidies. METHODS: Embryonic crown rump length (CRL), embryonic heart rate, gestational sac diameter (GSD) and yolk sac diameter (YSD) were measured by transvaginal sonography in 5603 live embryos from singleton pregnancies at 6-10 weeks' gestation. The measurements were expressed as differences from the expected normal mean for CRL (delta values) and median delta values in the aneuploid cases were compared to the euploid group. RESULTS: 5393 pregnancies resulted in the live birth of phenotypically normal neonates and these cases constituted the euploid group. In 55 cases there was subsequent prenatal diagnosis of aneuploidies (trisomy 21, n=28; trisomy 18, n=10; trisomy 13, n=10; triploidy, n=4; Turner syndrome, n=3). The median and interquartile range (IQR) of delta embryonic heart rate in trisomy 18 was -19.44 (-23.77 to -7.20)bpm and in trisomy 13 it was 11.12 (7.25 to 20.39)bpm, which were significantly lower and higher, respectively, than in euploid embryos (median -0.05, IQR -6.18 to 6.21bpm). The median delta YSD in trisomy 21 was higher than in euploid fetuses (median 0.56, IQR 0.23 to 0.79 and median -0.17, IQR -3.11 to 2.82 mm). There were no other significant differences in measurements between the groups. CONCLUSION: At 6-10 weeks' gestation there are sonographically detectable differences between euploid and trisomic embryos.