Fetal loss in the first trimester after demonstration of cardiac activity: relation of cytogenetic and ultrasound findings.
A retrospective comparison of cytogenetic and ultrasound findings in first trimester spontaneous fetal loss after demonstration of cardiac activity was made. The crown-rump length (CRL) was measured twice for each fetus resulting in spontaneous abortion: (i) CRL was measured in the viable state while demonstrating cardiac activity, and the growth deviation was expressed as the measured/expected CRL ratio (M/E CRL ratio); (ii) in the same fetus, CRL was measured after confirmation of fetal death, and designated as the post-mortem CRL. The chorionic tissues of these abortuses were karyotyped. The CRL of fetuses which resulted in normal deliveries were also measured as controls. As a result, 16 of 24 abortuses displayed an abnormal chromosomal analysis (67%). The mean M/E CRL ratio of still-viable fetuses was smaller than that of control fetuses (0.74 +/- 0.20 versus 0.98 +/- 0.13 respectively, P < 0.01). The differences in ratio between karyotypically normal and abnormal abortuses were not statistically significant. The post-mortem CRL of dead fetuses was > 20 mm in four of five monosomy X, two of three 21-trisomy, one of three triploidy and none of eight embryos with normal karyotype and five other trisomies. In conclusion, our study demonstrated that the M/E CRL ratio could be used as a predictor of spontaneous abortions, although it does not discriminate abnormal karyotypes from normal ones. The embryos with a post-mortem CRL more than 20 mm have a higher likelihood of suffering monosomy X or 21-trisomy. The ultrasonographic findings might offer a cytogenetic clue as to a possible cause to the developmental arrest.
Bessho
T
T
Department of Obstetrics and Gynaecology, Hyogo College of Medicine, Nishinomiya City, Japan.
Sakamoto
H
H
Shiotani
T
T
Komori
S
S
Koyama
K
K
D000022:Abortion, Spontaneous / Q000000981:diagnostic imaging* / Q000235:genetics*; D002869:Chromosome Aberrations; D018568:Crown-Rump Length; D005260:Female; D005865:Gestational Age; D006801:Humans; D007621:Karyotyping; D009006:Monosomy; D011123:Polyploidy; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies; D014314:Trisomy; D014463:Ultrasonography