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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
Pearl Toh, 3 days ago
The combination therapy comprising carfilzomib, cyclophosphamide and dexamethasone (KCd) is effective, with a tolerable safety profile, in an Asian cohort with high-risk multiple myeloma (MM) — thus providing a more economical alternative as a potential upfront regimen in resource-limited settings, according to leading experts during a myeloma education webinar.
Audrey Abella, 5 days ago
Extremes of sleep duration (≤5 or ≥10 hours/day), which is a known mortality risk factor in the general population, may increase absolute mortality in adults with type 2 diabetes (T2D), a prospective study has shown.
Pearl Toh, 21 Sep 2020
Early and sustained treatments with simplified regimen are the key to achieving good asthma control, said experts during a presentation at the ERS 2020 Congress.
Roshini Claire Anthony, 12 Oct 2020

Insulin icodec, an in-development basal insulin analogue administered once weekly, was as effective as once-daily insulin glargine in patients with type 2 diabetes (T2D) insufficiently controlled with metformin with or without a DPP-4* inhibitor, according to a phase II trial presented at EASD 2020.