Transvaginal Sonography And β-HCG Detection: Predictors Of Pregnancy Outcome In The Early Spontaneous Abortion

Objective:To explore the value of transvaginal sonography and serum beta human chorionic gonadotropin(β-HCG) levels to predict pregnancy outcome in the early spontaneous abortion.Methods:There were 736 cases of first-trimester pregnant patients performed with transvaginal scaning,covering a period from September 2006 to July 2008.the mean sac diameter and yolk sac and fetal heart beat were measured by transvaginal sonography.The change ofβ-HCG levels and pregnancy outcome was observed.There were 434 cases of spontaneous abortion inpatients,including 237 cases of threatened abortion patients, 197 cases of inevitable abortion patients,and 302 cases of normal pregnancy patients.Results:1 The gestation sac average growth rate of threatened abortion patients and normal pregnancy patients was faster than inevitable abortion patients,with a growth rate of＞1 mm/day,but the gestation sac average growth rate of inevitable abortion patients was＜1 mm/day.2 There were 8 cases of patients with small gestation sac size.1 case had threatened abortion,and 7 cases had inevitable abortions.There had different in Mean sac diameter(MSD) and MSD-CRL between small gestation sac patients and normal gestation sac patients.The difference had statistical significance(P＜0.05).3 There were 8 cases of patients with yolk sac smaller than normal,and 7 cases of patients with yolk sac more than 7.9 mm,all of them failed pregnancy.For those early spontaneous abortion patients at six to ten weeks gestation,in the condition of fetal pole existed,yolk sac did not exist or disappeared was correlated with failure of pregnancy.There were 12 patients with abnormal yolk sac shape,1 case had threatened abortion,11 cases had inevitable abortions.There were 4 cases of patients with hyperechogenic yolk sac,all of them had an abnormal outcome. 4 Patients with CRL of≥4 mm failed pregnancy if absent cardiac activity.5 The overall spontaneous abortion rate of subchorionic clot was 12.7%.The size of subchorionic clot greater than one-half of the chorionic sac circumference was found to be associated with inevitable abortion.6 There had different in serumβ-HCG levels at five to eight weeks gestation between threatened abortion and inevitable abortion,The difference had statistical significance (P＜0.05).At the same gestational age,β-HCG levels of threatened abortion were higher than inevitable abortion.Theβ-HCG levels of inevitable abortion rose slowly or fell rapidly.Conclusion:1 Patient with small gestation sac size or gestation sac average growth rate of＜1 mm /day should not be given an optimistic prognosis.2 yolk sac does not exist,disappear,smaller than normal,more than 7.9mm,abnormal shape or hyperechogenic is correlated with failure of pregnancy.3 With embryos more than 4.0 mm in crown-rump length,absent cardiac activity is associated with inevitable abortion.4 The size of the subchorionic clot can determine pregnancy outcome.The size of subchorionic clot greater than one-half of the chorionic sac circumference is correlated with failure of pregnancy.5 Patients withβ-HCG levels rising slowly or falling rapidly should not be given an optimistic prognosis.6 Yolk sac diameter and shape and fetal heart beat are the most risk factors for the inevitable abortion.