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Low foetal heart rate, small crown–rump length predict pregnancy loss

17 Aug 2020

Several predictors have been identified for pregnancy loss, which can be used by physicians for patient counseling and in deciding upon the frequency of follow-up sonograms, reports a study, stressing that the identified cut-points should not be used to diagnose nonviability.

Of the 617 participating women, 64 (10.4 percent) had a clinical pregnancy loss after their first ultrasound, seven (1.1 percent) were lost to follow-up, and 546 (88.5 percent) had a live birth.

Low foetal heart rate and small crown-rump length (≤122, 123, and 158 bpm; ≤6.0, 8.5, and 10.9 mm for gestational weeks 6, 7, and 8, respectively) were independently associated with clinical pregnancy loss. Pregnancies with both characteristics were at greatest risk (relative risk, 2.08, 95 percent confidence interval [CI], 1.24–2.91). The combination of low foetal heart rate and small crown–rump length resulted in a 16-percent (95 percent CI, 9.1–23) adjusted absolute increase in risk of subsequent loss, from 5.0 percent (95 percent CI, 1.5–8.5) to 21 percent (95 percent CI, 15–27).

Moreover, abnormal yolk sac diameter or the presence of a subchorionic haemorrhage did not improve prediction of clinical pregnancy loss.

This study was a secondary analysis of pregnant women enrolled in the Effects of Aspirin in Gestation and Reproduction trial. Participants had one to two previous pregnancy losses and no documented infertility. Each pregnancy had a single ultrasound with a detectable foetal heartbeat between 6 weeks 0 days and 8 weeks 6 days.

The investigators separately defined the cut-points for low foetal heart rate and small crown–rump length for gestational weeks 6, 7, and 8 to improve prediction. They used identity and log-binomial regression models to assess the absolute and relative risks, respectively, and 95 percent CIs between jointly categorized low foetal heart rate, small crown–rump length, and clinical pregnancy loss. Adjusted models accounted for gestational age at ultrasound in weeks. Finally, multiple imputation was used to address the missing data.

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Most Read Articles
13 Sep 2020
Regardless of birth weight, being obese at preschool age is associated with a greater risk of elevated blood pressure during early childhood, a recent China study has found. A longer duration of breastfeeding appears to help mitigate such a risk.
Jairia Dela Cruz, 3 days ago
In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.
06 Sep 2020
Type 2 diabetes mellitus patients taking proton pump inhibitors (PPIs) are at a higher risk of sustaining hip fractures, a recent study has found.
5 days ago
Osteoarthritis (OA) is the most common condition affecting the joints. Dr Lee Eu Jin, an Orthopaedic Surgeon from Liberty Orthopaedic Clinic at Mount Elizabeth Medical Centre, Singapore, shares his insights with Pearl Toh on how to manage OA in the primary care setting.