Abstract
Background: Many studies on the prognostic significance of the Yolk sac for the pregnancy outcome have been performed with conventional sonography and more recently with TVS. The results are conflicting. This prospective co relational study is conducted to assess the correlation of first trimester pregnancy outcome using yolk sac measurements and embryonic heart rate.
Material & Methods: A Hospital based prospective study done on 100 pregnant women between 6-9 weeks of gestation who were attending the antenatal clinic in Department of Obstetrics and Gynaecology, Mahatma Gandhi Hospital, Bhilwara, Rajasthan. Follow up scan: was done every two weeks where (gestational sac diameter, yolk sac diameter, crown rump length and fetal heart rate) were measured every time until the pregnancy reached 12 weeks.
Results: The Yolk sac size varied between 2.5 to 7.0 with a mean of 4.892 mm. The Yolk sac size has significant correlation with the first trimester pregnancy outcome. (T-test p=0.002**). The heart rate of the fetus predicted the first trimester pregnancy outcome significantly (T-test p=0.048*).
The gestational Age at the time of first scan predicted very significantly the first trimester pregnancy outcome (T-test p<0.001**). The Crown Rump Length (CRL) was ranged between 10 and 58 mm with a mean of 24.51 mm. The CRL has significant predictive value in first trimester pregnancy outcome (T-test p=0.044*).
Conclusion: We concluded that yolk sac size and the embryonic heart rate is a reliable, cost effective and beneficial in predicting first trimester pregnancy outcome especially in patients who conceive following IVF.
Keywords: First trimester pregnancy, Yolk sac size, Crown rump length, Gestational age, Heart rate.
References
- Siddiqi TA, Caligaris JT, Miodovnik M et al.: Rate of spontaneous abortion after first trimester sonographic demonstration of fetal cardiac activity. Am. J. Perinatol.1988; 5(1): 1-4.
- Berdahl DM, Blaine J, Van Voorhis B et al.: Detection of enlarged yolk sac on early ultrasound is associated with adverse pregnancy outcomes. Fertil. Steril.,2010; 94:1535–1537.
- Kaur A and Kaur A: Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. J.Pharm. Bioallied. Sci.,2011; 3(3): 329-338.
- Lyons EA and Levi CS: The first trimester. In: Diagnostic Ultrasound. Rumack CM, Wilson SR, Charboneau JW (eds).3rd ed. Mosby Co.London.pp: 2005; 1070–1100.
- Knudsen UB, Hansen V, Juul S, Secher NJ. Prognosis of a new pregnancy following previous spontaneous abortions. Eur J Obstet Gynecol Reprod Biol 1991;39:31–6.
- Smith, K.E. and Buyalos, R.P. The profound impact of patient age on pregnancy outcome after early detection of fetal cardiac activity. Steril.,1996; 65, 35–40.
- ‘Gestational sac’ volumes as determined by sonar in the first trimester of pregnancy, Robinson HP. Br J Obstet Gynaecol 1975; 82: 100–107.
- Gestational sac diameter in very early pregnancy as a predictor of fetal outcome. Oh JS, Wright G, Coulam CB. Ultrasound Obstet Gynecol 2002; 20:
- Goldstein SR.Embryonic death in early pregnancy: a new look at the first , Obstet Gynecol 1994; 84: 294–297.
- Cepni I, Bese T, Ocal P, Budak E, Idil M, Aksu MF. Significance of yolk sac measurements with vaginal sonography in the first trimester in the prediction of pregnancy outcome. Acta Obstet Gynecol Scand 1997;76: 969–72.
- Blaas HG, Eik-Nes SH, Bremnes JB. The growth of the human embryo. A longitudinal biometric assessment from 7 to 12 weeks of gestation. Ultrasound Obstet Gynecol 1998;12:346–54.
- Schouwink MH, Fong BF, Mol BW, van der Veen F. Ultrasonographic criteria for non-viability of first trimester intra-uterine pregnancy.. Early Pregnancy 2000;4:203–13.
- Stampone C, Nicotra M, Muttinelli C, Cosmi EV. Transvaginal sonography of the yolk sac in normal and abnormal pregnancy. J Clin Ultrasound 1996;24:3–9.
- 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.
- Berdahl DM, Blaine J, Van Voorhis B, Dokras A. Detection of enlarged yolk sac on early ultrasound is associated with adverse pregnancy outcomes. Fertil Steril. 2010 Sep; 94(4):1535-7. Epub 2010 Feb
- Liao AW, Snijders R, Geerts L, Spencer K, Nicolaides KH. Fetal heart rate in chromosomally abnormal fetuses. Ultrasound Obstet Gynecol 2000; 16: 610–613.
- Jauniaux, E., Gavrill, P., Khun, P. et al. Fetal heart rate and umbilicoplacental Doppler flow velocity waveforms in early pregnancies with a chromosomal abnormality and/or an increased nuchal translucency thickness. Reprod. 1996; 11, 435–439.
- Snijders RJ, Sebire NJ, Nicolaides KH. Maternal and gestational age specific risk for chromosomal defects. Fetal Diagn Ther 1995; 10: 356–367.
- Gustavii B. Chorionic biopsy and miscarriage Lanc et 1984; 1:562.
- Reljic M. The significance of crown-rump length measurement for predicting adverse pregnancy outcome of threatened abortion. Ultrasound Obstet Gynecol. 2001 Jun;17(6):510-2.
Corresponding Author
Dr Sapna Aseri
MS (Obst & gynae), Senior Resident, Department of Obs & Gynaecology
RVRS Medical College & Attached groups of Mahatma Gandhi Hospital, Bhilwara, Raj, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i4.177
