Pilot study establishing a nomogram of yolk sac growth during the first trimester of pregnancy.
pregnancy
pregnancy loss
ultrasound
yolk sac
Journal
The journal of obstetrics and gynaecology research
ISSN: 1447-0756
Titre abrégé: J Obstet Gynaecol Res
Pays: Australia
ID NLM: 9612761
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
06
12
2018
accepted:
15
11
2019
pubmed:
10
12
2019
medline:
24
11
2020
entrez:
10
12
2019
Statut:
ppublish
Résumé
The yolk sac (YS) has been reported as a reliable predictor of adverse pregnancy outcomes, however, it has always been evaluated cross-sectionally with a single ultrasound per patient. We sought to validate the use of YS dimensions in serial ultrasounds throughout the first 10 weeks of singleton and multiple gestations. This was a prospective cohort study where YS diameters were serially obtained with 2D ultrasound in singleton and multiple gestations from 5 to 11 weeks. Nonparametric test were used for comparisons with P < 0.05 indicating significance. One hundred ninety-three patients were included, 42 twins (3 monochorionic and 39 dichorionic), 2 triplets (monochorionic twins plus a singleton) and 148 singleton pregnancies (238 total fetuses). There was no difference in YS dimensions in singleton versus multiple pregnancies. Starting at 5 weeks' gestation, the YS increased 0.4 mm (95% CI 0.3-0.5 mm) per week until 10 weeks' gestation. Forty-five fetuses were lost in the first trimester. The risk of pregnancy loss was higher with a large YS until 8 weeks (P ≤ 0.001), while after 8 weeks it was higher with a small YS (P < 0.005). We established a nomogram of YS development during the first 10 weeks of pregnancy. The YS reliably detected pregnancies that ended in loss as early as 6 weeks' gestation. The YS was either smaller or larger than in ongoing pregnancies. While all pregnancies with large YS were lost within 10 weeks, those with smaller YS were lost beyond the first 10 weeks.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
223-228Subventions
Organisme : University of Tennessee Health Science Center
ID : E07-3225-001
Informations de copyright
© 2019 Japan Society of Obstetrics and Gynecology.
Références
Levi CS, Lyons EA. Yolk sac number, size and morphologic features in monochorionic monoamniotic twin pregnancy. In: Rumack CM, Levine D (eds). Diagnostic Ultrasound E-Book. Chapter 30: The First Trimester, 5th edn. Philadelphia, PA: Elsevier, 2018; 1048-1087.
Lindsay DJ, Lovett IS, Lyons EA et al. Yolk sac diameter and shape at endovaginal US: Predictors of pregnancy outcome in the first trimester. Radiology 1992; 183: 115-118.
Pereda J, Niimi G. Embryonic erythropoiesis in human yolk sac: Two different compartments for two different processes. Microsc Res Tech 2008; 71: 856-862.
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; 94: 1535-1537.
Gabbay-Benziv R, Dolev A, Bardin R, Meizner I, Fisch B, Ben-Haroush A. Predication of fetal loss by first-trimester crown-rump length in IVF pregnancies. Arch Gynecol Obstet 2017; 295: 771-775.
Soyoung B, Karnitis J. Triple ultrasound markers including fetal cardiac activity are related to miscarriage risk. Fertil Steril 2011; 96: 1145-1148.
Tan S, Gülden Tangal N, Kanat-Pektas M et al. Abnormal sonographic appearances of the yolk sac: Which can be associated with adverse perinatal outcome? Med Ultrasound 2014; 16: 15-20.
Doubilet PM, Benson CB, Bourne T et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med 2013; 369: 1443-1451.
Doubilet PM, Benson CB, Chow JS. Long-term prognosis of pregnancies complicated by slow embryonic heart rates in the early first trimester. J Ultrasound Med 1999; 18: 537-541.
Goldstein SR, Kerenyi T, Scher J, Papp C. Correlation between karyotype and ultrasound findings in patients with failed early pregnancy. Ultrasound Obstet Gynecol 1996; 8: 14-317.
Yoneda S, Shiozaki A, Yoneda N et al. A yolk sac larger than 5 mm suggests an abnormal fetal karyotype, whereas an absent embryo indicates a normal fetal karyotype. J Ultrasound Med 2018; 37: 1233-1241.