Sonographic Parameters for Prediction of Miscarriage: Role of 3-Dimensional Volume Measurement.
OBJECTIVE
To evaluate the value of volume measurement using 3-dimensional sonography for prediction of miscarriage.


METHODS
We prospectively enrolled 188 singleton pregnant women at 5 to 9 weeks' gestation. The 3-dimensional sonographic gestational sac volume and yolk sac volume were measured together with the fetal heart rate, gestational sac diameter, and yolk sac diameter. For each sonographic parameter, nomograms were created; z scores were calculated for each measurement, and the values were compared between miscarriage and ongoing pregnancy groups. Sonographic parameters for prediction of miscarriage were evaluated by multivariate analysis, and the screening performance was assessed by a receiver operating characteristic curve.


RESULTS
Among the 188 pregnancies, 30 (16.0%) had miscarriage. Multivariate analysis showed that fetal heart rate below the 5th percentile (odds ratio, 6.43), gestational sac diameter below the 5th percentile (odds ratio, 4.87), gestational sac volume below the 5th percentile (odds ratio, 5.25), and yolk sac diameter below the 2.5th or above the 97.5th percentile (odds ratio, 15.86) were significant predictors of miscarriage (P = .018; P = .018; P = .033; and P < .001, respectively). At a false-positive rate of 30%, the detection rate for miscarriage in screening by a combination of fetal heart rate, gestational sac diameter, gestational sac volume, and yolk sac diameter was 77.8%.


CONCLUSIONS
A small-for-gestational-age gestational sac volume is a significant sonographic predictor of miscarriage, as are fetal bradycardia, a small gestational sac diameter, and a small or large yolk sac diameter.
Department of Obstetrics and Gynecology (J.H.W., S.J.K., J.C.S., J.Y.K., I.Y.P.) and Physiology Laboratory (S.C.), Catholic University of Korea, Seoul, Korea.
Jeong Ha
JH
Wie
Department of Obstetrics and Gynecology (J.H.W., S.J.K., J.C.S., J.Y.K., I.Y.P.) and Physiology Laboratory (S.C.), Catholic University of Korea, Seoul, Korea.
Suyearn
S
Choe
Department of Obstetrics and Gynecology (J.H.W., S.J.K., J.C.S., J.Y.K., I.Y.P.) and Physiology Laboratory (S.C.), Catholic University of Korea, Seoul, Korea.
Sa Jin
SJ
Kim
Department of Obstetrics and Gynecology (J.H.W., S.J.K., J.C.S., J.Y.K., I.Y.P.) and Physiology Laboratory (S.C.), Catholic University of Korea, Seoul, Korea.
Jong Chul
JC
Shin
Department of Obstetrics and Gynecology (J.H.W., S.J.K., J.C.S., J.Y.K., I.Y.P.) and Physiology Laboratory (S.C.), Catholic University of Korea, Seoul, Korea. jiyoungk@catholic.ac.kr ooooobbbbb@catholic.ac.kr.
Ji Young
JY
Kwon
Department of Obstetrics and Gynecology (J.H.W., S.J.K., J.C.S., J.Y.K., I.Y.P.) and Physiology Laboratory (S.C.), Catholic University of Korea, Seoul, Korea. jiyoungk@catholic.ac.kr ooooobbbbb@catholic.ac.kr.
In Yang
IY
Park
D000022:Abortion, Spontaneous / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D000328:Adult; D005260:Female; D058746:Gestational Sac / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods / Q000706:statistics & numerical data*; D015994:Incidence; D011247:Pregnancy; D011379:Prognosis; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal / Q000379:methods / Q000706:statistics & numerical data*; D015017:Yolk Sac / Q000000981:diagnostic imaging*
3-dimensional volume; gestational sac volume; miscarriage; obstetric ultrasound; predictor; sonography