الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Summary
Trans-vaginal sonography is the procedure of choice in
evaluating the viability of embryos early in pregnancy.
Previous reports have shown that trans-vaginal sonography can
identify early pregnancy with confidence, correlating certain
growth parameters of the pregnancy with the menstrual
history.
The term ”viability” implies the ability to live
independently outside the uterus and, strictly speaking, cannot
be applied to embryonic and early fetal life. However, this
term has been accepted in ultrasound jargon to mean that the
embryonic or fetal heart is seen to be active and this is taken to
mean the conceptus is alive.
The measurements of embryonic length and heart rate (HR)
and those of the gestational sac diameter (GSD) and yolk sac
diameter (YSD) have been used for assessment of gestational
age (GA) and prediction of adverse pregnancy outcome, such
as miscarriage.
Some previous studies tried to find the predictability of
each parameter but results were different among studies.
In this current study; trans-vaginal ultrasound was done
measuring to 233 pregnant women with pregnancy of
uncertain viability. Mean gestational sac diameter, yolk sac
diameter and crown rump length were the parameters studied.
Summary
112
The inclusion criteria were pregnancy of uncertain viability
in the study period, gestational age by the menstrual period <
84 days, and finding at trans-vaginal sonography of one of a
single intrauterine gestational sac with mean sac diameter < 20
mm and with no visible embryonic structures (empty sac),
single intrauterine gestational sac containing an embryonic
pole with maximum length < 6 mm and no embryonic heart
pulsation (small embryo) or a single intrauterine gestational
sac with mean sac diameter < 25 mm and a visible yolk sac but
no visible embryonic pole (yolk sac only).
The exclusion criteria were women who will undergo
termination of pregnancy or women with multiple pregnancies.
Before being admitted to the clinical study, all enrolled
women consented to participate after the nature, scope, and
possible consequences of the clinical study had been explained
in a form understandable to them. Only their numbers and
initials were recorded.
There was a statistically significant result of mean
gestational sac diameter with a positive fetal echo inside to
consider the cut-off value of 15.2 mm as a good positive
predictor of fetal viability.
Regarding mean gestational sac diameter in the absence of
fetal echo inside, crown rump length, yolk sac diameter, there
was no statistically significant result of any diameter of each to
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113
be considered as a good predictor of fetal viability.For the
mean gestational sac diameter in all pregnant women involved,
the best cut-off value was 20.9 mm (+ve LR=8.3, -ve LR=0.9).
The area under the curve for this parameter was 0.625 with a
confidence interval (0.5-0.7).For the mean gestational sac
diameter in the pregnant women where no fetal echo was
present at the first scan, the best cut-off value was 20.9 mm
(+ve LR=8.9, -ve LR=0.93). Area under the curve for this
parameter was 0.594 with a confidence interval (0.5-0.7).For
the crown rump length and the yolk sac diameter, no single
value for these two diameters could be considered as a cut-off
value.
Concluding our results, the use of logistic regression model
did not allow prediction of pregnancy viability in pregnancies
of uncertain viability. Mean gestational sac diameter was the
only parameter having a significant effect on the outcome with
cut-off values of 20 mm generally and if the sac was empty
and 15 mm if there was a fetal echo inside.
These results are corresponding with many recent
literatures trying to support conservative management to stop
termination of pregnancies that may be viable. As all
parameters are inconclusive, follow-up scan is recommended
in most guidelines with conflict about the interval between
first scan and follow up scan.