Evidence of early first-trimester growth restriction in pregnancies that subsequently end in miscarriage
Article first published online: 11 AUG 2008
© 2008 The Authors Journal compilation © RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 115, Issue 10, pages 1273–1278, September 2008
How to Cite
Mukri, F., Bourne, T., Bottomley, C., Schoeb, C., Kirk, E. and Papageorghiou, A. (2008), Evidence of early first-trimester growth restriction in pregnancies that subsequently end in miscarriage. BJOG: An International Journal of Obstetrics & Gynaecology, 115: 1273–1278. doi: 10.1111/j.1471-0528.2008.01833.x
- Issue published online: 11 AUG 2008
- Article first published online: 11 AUG 2008
- Accepted 27 May 2008.
- Early pregnancy;
- growth restriction;
Objectives To examine whether viable early pregnancies that subsequently end in miscarriage exhibit evidence of first-trimester growth restriction.
Design Prospective cohort study.
Setting Early pregnancy unit (EPU) of a teaching hospital.
Population Women attending EPU between 5 and 10 weeks of gestation.
Methods Women with spontaneously conceived intrauterine, viable singleton pregnancies with certain last menstrual period and regular cycles were included. The deviation between the observed and expected crown–rump length (CRL) for gestation was calculated and expressed as a z score. Pregnancies were followed up until the 11–14 week scan, and the deviation between those that remained viable and miscarried subsequently was calculated.
Main outcome measures Viability at 11–14 week scan.
Results Over 6 months, 316 women met the inclusion criteria. Twenty-four (7.4%) women were excluded. Of the remaining 292, the pregnancy remained viable in 251 (86%) and 41 (14%) suffered a miscarriage. At the first transvaginal ultrasound, the z score of the mean measured CRL for pregnancies that remained viable was −0.82, SD 1.46, while in pregnancies that subsequently miscarried the z score was −2.42 and the CRL was significantly smaller, SD 1.31 (P < 0.0001). In the latter group, the initial CRL was below the expected mean for gestational age in all women, while in 61% (25/41), the CRL was at least 2 SDs below the expected mean.
Conclusions CRL was significantly smaller in pregnancies that subsequently ended in miscarriage. This suggests that early first-trimester growth restriction is associated with subsequent intrauterine death.