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Knowing the predictors of pregnancy outcomes in patients with recurrent spontaneous abortion (RSA) is extremely critical. Accordingly, we aimed to determine the effects of the difference between mean gestational sac diameter and crown-rump length (mGSD-CRL) on the pregnancy outcomes in patients with RSA at 6–10 gestational weeks, as well as to explore its significance in predicting the pregnancy outcomes of patients with RSA. This retrospective cohort study included 256 pregnant women at 6–10 weeks of gestation and with RSA who had visited our hospital from January 2020 to March 2023. The patients were allocated to three groups based on the mGSD-CRL difference: Group A: mGSD-CRL ≤ 10 mm, Group B: 10 mm < mGSD-CRL ≤ 15 mm, and Group C: mGSD-CRL > 15 mm. The pregnancy failure rate in Group A was 22%, which was higher than those that in Group B (5.5%) and Group C (9.4%), with statistically significant differences ( P  < 0.05). Binary logistic regression analysis revealed that the mGSD (odd ratio [OR] = 1.14, 95% confidence interval [CI] = 1.06–1.23, P  = 0.001), the CRL (OR = 1.16, 95% CI = 1.05–1.28, P  = 0.004), and mGSD-CRL (OR = 1.12, 95% CI = 1.01–1.24, P  = 0.026) were independent risk factors affecting the pregnancy outcome of patients with RSA. However, the uterine artery peak systolic value to end-diastolic value (UtA-S/D), D-dimer (DD), adenosine diphosphate (ADP), and arachidonic acid (AA) were not related ( P  > 0.05). The area under the receiver operator characteristic (ROC) curve of mGSD-CRL at 6–10 weeks of pregnancy was 0.566, with a cutoff value of 9.50 mm. The sensitivity and specificity were 90% and 36%, respectively. Compared with their prediction value, the combined prediction of mGSD-CRL, mGSD, and CRL exhibited a higher value (AUC = 0.718) in predicting pregnancy outcomes. A weak negative correlation was detected between ADP and mGSD-CRL difference ( r  = − 0.165, P  = 0.025). In patients with RSA, mGSD-CRL acts as an independent risk factor affecting pregnancy outcomes, thereby effectively predicting the early pregnancy outcomes of patients with RSA. Thus, a low mGSD-CRL difference signifies the heightened probability of miscarriage, thereby urgently requiring clinicians to pay timely attention. Trial registration: The study is registered at ClinincalTrails.gov (Trial registration number: NCT06081556, October 13, 2023).

Background This study aimed to develop a new ultrasonographic dating formula to estimate gestational age (GA) based on fetal crown–rump length (CRL) in a Chinese population, evaluate model accuracy and compare its performance with established dating formulas. Methods A prospective, multicenter study was conducted across mainland China. Participants included healthy, low-risk women with spontaneously conceived singleton pregnancies and a regular menstrual cycle in the preceding year. Ultrasonography was performed between 11 and 14 weeks of gestation, with GA determined based on the last menstrual period. Participants were randomly assigned to a development or validation cohort in a 7:3 ratio. A best-fit regression model was constructed for GA estimation based on CRL in the development cohort. For validation, mean differences between the new estimated GA and menstrual age were calculated and compared with those obtained using five established CRL-based dating formulas in the validation cohort. All participants were followed through to delivery. Results The study recruited 4,710 women with singleton pregnancies, with 3,297 in the development cohort and 1,413 women in the validation cohort. The mean and standard deviation values of CRL changed linearly with GA during 11–14 weeks. CRL demonstrated a linear relationship with GA between 11 and 14 weeks, yielding the regression equation GA = 59.590085 + 0.458539×CRL (R 2  = 0.8042). The mean difference between estimated GA and menstrual age was 0.32 days (95% confidence interval 0.17–0.46), demonstrating a smaller error compared with those obtained from the five widely used CRL dating formulas. Conclusions We derived a CRL-based dating formula applicable to naturally conceived pregnancies at 11–14 weeks. This new formula exhibits small residuals, providing a more accurate alternative to existing CRL-based dating formulas.

Infant undernutrition, defined by length‐ and weight‐based indices, is common in low‐ and middle‐income countries (LMICs), but corresponding deficits in head size have received less attention. In a cohort of term newborns in Dhaka, Bangladesh, we compared the severity of deficits (vs. World Health Organization Growth Standards) in head circumference (HC), length and weight at birth and every 3 months until 2 years of age (n range across timepoints: 843–920). We estimated the mean and 25th, 50th and 75th percentiles of HC‐, length‐ and weight‐for‐age z‐scores (HCZ, LAZ and WAZ, respectively). Differences between HCZ and LAZ (or WAZ) were analyzed using paired t tests and quantile regression. We also derived HCZ using height‐age instead of chronological age at 3–24 months. Mean HCZ was significantly higher than mean LAZ and WAZ at birth, but HCZ was significantly lower than LAZ at 6, 9 and 12 months and the HCZ and LAZ deficits were similar from 15 to 24 months. Mean HCZ was lower than WAZ at all ages beyond birth. Patterns were broadly consistent at the 25th, 50th and 75th percentiles. The HCZ deficit remained evident when HC was standardized using height‐age at all ages beyond birth, indicating HC was reduced relative to body size. In conclusion, among term‐born children in Dhaka, HCs were smaller than international standards at all ages up to 2 years, and there was no evidence of postnatal head sparing. Consideration should be given to routine measurement of HC in population health surveys in LMICs. Term infants in Bangladesh had smaller head circumferences compared to international standards. In the postnatal period (3–24 months of age), average deficits in head circumference were more severe than expected based on body lengths, indicating a lack of head‐sparing in a setting where early childhood undernutrition is widespread. Summary In a Bangladeshi cohort of term infants, average head circumference (HC) z‐scores were closer to international norms than corresponding length and weight z‐scores at birth, suggesting possible foetal head sparing. Postnatal head sparing was not observed among children in Dhaka at any timepoint following birth. At 6, 9 and 12 months of age, the HC distribution was further below the international norm compared to the length and weight distributions. Analyses using height‐age rather than chronological age showed that postnatal HC deficits were more severe than expected given children's average height, at all timepoints following birth. The entire HC distribution was negatively displaced relative to the international standard at all ages, indicating that the head size deficit is a whole‐population condition, analogous to linear growth faltering. HC, like length and weight, should be considered for routine monitoring in LMIC settings where early childhood undernutrition is common.

Background Selective intrauterine foetal growth restriction (sIUGR) and twin–twin transfusion syndrome (TTTS) are common complications in Monochorionic diamniotic (MCDA) twin pregnancies. Timely and accurate diagnosis and intervention are essential to improve perinatal outcomes. The purpose of this study was to determine the value of differences in crown - rump lengths (CRL) and nuchal translucency (NT) and evaluate the significance of differences in embryo length in predicting the occurrence of sIUGR and TTTS. Methods This research is a retrospective study that includes cases of MCDA twins diagnosed via ultrasound in the Obstetrics Department of Shandong Provincial Hospital Affiliated to Shandong University from January 2017 to March 2024. These cases were categorized into sIUGR group, TTTS group, TTTS with sIUGR group and normal MCDA group, based on the presence of complex twin related complications. For each group, embryo length, CRL and NT measured by ultrasound during the 7–14 week gestation period were respectively recorded. The differences in embryo length, CRL and NT between the normal MCDA twin group and sIUGR group, TTTS group, as well as TTTS with sIUGR group were compared. The Mann‒Whitney U test and the chi‒square test were utilized for the analysis. Furthermore, the receiver operating characteristic (ROC) curve was plotted to conduct further analysis. Results A total of 722 MCDA twins (203 with sIUGR, 158 with TTTS, 55 with TTTS with sIUGR and 306 controls) were included. The difference in the CRL in the sIUGR group (9.43%) was significantly greater than that in the control group (3.30%) ( P  < 0.001). However, no statistically significant difference in NT or embryo length was detected ( P  = 0.271, 0.567). The difference in CRL could not be used to distinguish between sIUGR-type I and sIUGR-type II/III ( P  = 0.35). ROC analysis revealed that the difference in CRL predicted sIUGR with an area under the curve of 0.78; for comparison, the area under the curve for the prediction of TTTS was 0.51. The prediction of sIUGR using the CRL difference threshold of 7.38% had a sensitivity of 80.72% and a specificity of 67%, a positive predictive value (PPV) of 67%, and a negative predictive value (NPV) of 80.72%. Conclusions In MCDA twin pregnancies, the difference in the first-trimester CRL was valuable for predicting the occurrence of sIUGR but was not associated with TTTS. Embryo length and NT did not significantly differ among the groups. Trial registration Not applicable.

PurposeThe aim of this study was to determine whether first trimester ultrasound measurements of crown rump length (CRL) and gestational sac diameter (GSD) differ depending on the method of conception among infertile women.MethodInfertile women, ages 21–50 years old, who conceived viable, singleton pregnancies via fresh embryo transfer (ET), frozen ET, non-in vitro fertilization (IVF) fertility treatment, or spontaneously were included in this observational cohort study at an academic fertility practice. Embryonic growth trajectories defined by the CRL and GSD at 6 and 8 weeks’ gestation were analyzed and compared among the methods of conception.ResultsCrown rump length at 6 weeks’ gestation was smaller for conceptions achieved via fresh ET compared with frozen ET in a natural cycle (1.50 vs. 2.50 mm, p = 0.017). Crown rump length was smaller at 8 weeks’ gestation in conceptions achieved via fresh ET compared to frozen ET in a programmed cycle (16.13 vs. 17.02 mm, p = 0.039).ConclusionAmong infertile women, embryo growth may differ between fresh and frozen ET as early as 6 and 8 weeks’ gestation.

Twins achieved through in-vitro fertilisation often undergo a viability ultrasound at 6–9 weeks of gestation. The presence of inter-twin crown-rump length discordance at this stage is not an uncommon finding; however the clinical significance of this is unknown. We analyzed 218 dichorionic twin pregnancies, producing two live fetuses > 24 weeks gestation, to determine whether inter-twin discordance (≥ 85th centile) in the mid-first trimester was associated with birthweight discordance (> 20%), or small for gestational age (< 10th centile). The incidence of birthweight discordance and small for gestational age infants were determined, with no increased risk found for the discordant population. This may provide some reassurance to treating clinicians.

ObjectiveTo evaluate the association between small crown–rump length (CRL) and fetal loss ≤22 weeks in IVF pregnancies.MethodsA retrospective analysis of prospectively collected data at a university-affiliated medical center. All singleton IVF pregnancies within a 5-year period, with a live embryo on first-trimester ultrasound and verified pregnancy outcome were included. Rates of fetal loss ≤22 weeks were compared between pregnancies with a CRL ≤tenth percentile and above the tenth percentile of our population.ResultsOverall, 397 pregnancies met inclusion criteria. Ninety-five percent of CRL measurements were performed at 40–80 gestational days. All live-embryo’s CRL measurements, from 40 to 80 mm, were plotted against expected gestational age (in 5-day clusters), with calculation of the tenth percentile for every gestational age. Total of 64 pregnancies had CRL ≤tenth percentile for gestational age. The rate of fetal loss in this group was significantly higher than in pregnancies with CRL >tenth percentile (17.2 vs. 6.6%, p = 0.005, OR = 2.93, 95% CI 1.2–6.7). In both groups, the majority of fetal losses occurred ≤10 weeks of gestation.ConclusionIn IVF pregnancies with a live embryo, a small CRL at 40–80 days’ gestation may predict fetal loss. Repeated ultrasound should be considered after 1–2 weeks.

Background: Estimation of fetal age by ultrasound assumes identical biometries for both sexes at identical gestational ages. However, late in the first trimester male fetuses become larger overall than female fetuses, which may introduce a sex bias with clinical consequences. A recent study showed that using due-date estimates based on biparietal diameter from the second trimester increased the post-term male-to-female ratio and the risk of stillbirth among female fetuses born at 43 gestational weeks. We aimed to evaluate whether this increased male-to-female ratio was also present when the due date was based on crown-rump length from the first trimester. Methods: The study population included 3987 women with a certain last menstrual period (LMP), as well as a crown-rump length measured in the first trimester and a biparietal diameter measured in the second trimester. We defined birth after 42 completed weeks estimated by LMP as post-term. Labor was not routinely induced until after 42 weeks. Male-to-female ratios were estimated using logistic regression. Results: When gestational age was estimated by biparietal diameter, the sex ratio steadily increased from 0.98 (95% confidence interval = 0.87–1.11) in week 40 to 1.54 (1.09–2.17) in week 42. A similar increase did not occur when using certain LMP or crownrump length. Conclusions: The use of crown-rump length for the estimation of gestational age is not associated with an increased post-term male-to-female ratio. It can therefore be used for the estimation of due date without risk of the sex bias that occurs when using biparietal diameter in second trimester of pregnancy.

Determining the viability of a pregnancy is a major challenge, especially with a pregnancy of unknown location. This review provides specific guidance, including stringent criteria for nonviability, that can reduce the risk of inadvertent harm to a potentially normal pregnancy. Over the past two to three decades, pelvic ultrasonography and measurement of the serum concentration of human chorionic gonadotropin (hCG) (Table 1) have become mainstays in the diagnosis and management of early-pregnancy problems. These tests, which allow earlier detection of pregnancy and more accurate diagnosis of its complications than were previously possible, have revolutionized the management of intrauterine pregnancies and markedly reduced the morbidity and mortality associated with ectopic pregnancy. 1 , 2 Although these tests have indisputable benefits, their misuse and misinterpretation can lead to interventions that inadvertently damage pregnancies that might have had normal outcomes. 3 , 4 There are well-documented instances . . .