title: A model and scoring system to predict outcome of intrauterine pregnancies of uncertain viability.
abstract: OBJECTIVE
  To define the incidence and outcome of intrauterine pregnancy of uncertain viability (PUV) and to develop and assess the performance of a model and a scoring system to predict ongoing viability.
  
  
  METHODS
  Of 1881 consecutive women undergoing transvaginal ultrasonography, a cohort of 493 women with an empty gestational sac < 20 mm in mean diameter, gestational sac < 25 mm in mean diameter and containing yolk sac only or an embryonic pole < 6 mm in maximum length and without visible heart activity were followed until the end of the first trimester. Women with multiple pregnancies or who underwent termination of pregnancy were excluded. Outcome measures were pregnancy viability at initial 7-14-day follow-up and first-trimester viability at 11-14 weeks. The data were split randomly into two sets (two-thirds and one-third, respectively) in order to first develop and then test a mathematical model and a 'simple' model in the prediction of viability at each outcome point, based on maternal demographics, ultrasound features and symptoms. The performance of each system was assessed by receiver-operating characteristics (ROC) curve analysis and calibration plots on a test dataset.
  
  
  RESULTS
  The incidence of PUV in this population was 29.2% (549/1881). Of the 493 pregnancies with initial (7-14 days) follow-up available, 307 (62.3%) were viable at this time and of the 444 pregnancies with follow-up at the end of the first trimester, 225 (50.7%) were still viable. Initial (7-14-day) viability was predicted by the model with an area under the ROC curve (AUC) of 0.837 (95% CI, 0.791-0.884) in the training dataset and 0.821 (95% CI, 0.756-0.885) in the test dataset. First-trimester (11-14-week) viability was predicted by the model with an AUC of 0.788 (95% CI, 0.734-0.842) in the training dataset and 0.774 (95% CI, 0.701-0.848) in the test dataset. The scoring system performed slightly worse than did the model, but had the advantage of being easily applicable.
  
  
  CONCLUSIONS
  When early pregnancy viability cannot be established immediately with ultrasound, use of either a logistic regression model or a scoring system allows an individualized prediction of first-trimester outcome.
authors.affiliation: Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital London, London, UK. ceciliabottomley@doctors.org.uk
authors.forename: C
authors.initials: C
authors.lastname: Bottomley
authors.forename: V
authors.initials: V
authors.lastname: Van Belle
authors.forename: A
authors.initials: A
authors.lastname: Pexsters
authors.forename: A T
authors.initials: AT
authors.lastname: Papageorghiou
authors.forename: F
authors.initials: F
authors.lastname: Mukri
authors.forename: E
authors.initials: E
authors.lastname: Kirk
authors.forename: S
authors.initials: S
authors.lastname: Van Huffel
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
authors.forename: T
authors.initials: T
authors.lastname: Bourne
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014621:Vagina / Q000000981:diagnostic imaging*; D055815:Young Adult