Ucyigit A, Fuller J L, Poon L C, Johns J, Ross J A
Early Pregnancy and Acute Gynaecology Unit, Golden Jubilee Wing, King's College Hospital, Denmark Hill, London, SE5 9RS, England, United Kingdom.
Early Pregnancy Unit, Queen Elizabeth Hospital, Stadium Road, Woolwich, London, SE18 4QH, England, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2021 Mar;258:294-298. doi: 10.1016/j.ejogrb.2021.01.013. Epub 2021 Jan 12.
The primary objective of this study was to ascertain whether there is association between low initial serum progesterone, sonographic parameters and clinical outcomes in women presenting with pregnancies of unknown location (PUL), which are found to be ongoing at their follow up scans in the first trimester.
This was a non-interventional retrospective cohort study of 1056 patients spanning a 14-year period, conducted in the Early Pregnancy Unit (EPU) of an inner-city teaching hospital. Patients who had an ongoing singleton first trimester pregnancy after presenting with PUL were identified and categorised as having low progesterone if it was 32 nmol/l or lower. The crown-rump length (CRL), mean gestational sac diameter (MGSD) and gestational sac volume (GSV) were measured when the embryo was first seen, and the pregnancy outcome recorded.
Pregnancies with low progesterone tended to have smaller gestational sacs (GS) on follow up scan (p = 0.001) and the sac was smaller than expected for a given CRL (p = 0.000). There was no ultrasound parameter that was characteristic of low progesterone. The observation of a smaller than expected MGSD for a given CRL remained even when only pregnancies with normal outcomes were analysed. Clinical outcome data were available for 854 (80.9 %) women. Overall, 81.4 % (n = 34/43) of pregnancies with low progesterone resulted in livebirth, compared to 91.7 % (n = 744/811) livebirths in pregnancies with higher levels (p = 0.0454).
Pregnancies with low progesterone tend to have a smaller GS compared to those with a higher progesterone, and the GSs are smaller than expected for a given CRL. The current study shows that women with low progesterone at the start of pregnancy remain at higher risk of miscarriage, even when the pregnancy is initially found to be viable in the first trimester. These pregnancies also tend to be associated with the sonographic finding of a smaller GS than expected for a given gestational age, regardless of eventual outcome.
本研究的主要目的是确定在妊娠初期血清孕酮水平较低、超声参数与妊娠部位不明（PUL）女性的临床结局之间是否存在关联，这些女性在孕早期的随访扫描中被发现妊娠仍在继续。
这是一项在市中心一家教学医院的早期妊娠单元（EPU）进行的非干预性回顾性队列研究，研究对象为1056例患者，时间跨度为14年。确定那些在出现PUL后妊娠仍在继续的单胎妊娠女性，并将血清孕酮水平为32 nmol/l或更低的患者归类为孕酮水平低。在首次观察到胚胎时测量头臀长度（CRL）、平均孕囊直径（MGSD）和孕囊体积（GSV），并记录妊娠结局。
孕酮水平低的妊娠在随访扫描时孕囊往往较小（p = 0.001），且孕囊小于给定CRL预期的大小（p = 0.000）。没有超声参数是孕酮水平低的特征性表现。即使仅分析结局正常的妊娠，对于给定的CRL，观察到的MGSD小于预期的情况仍然存在。854名（80.9%）女性有临床结局数据。总体而言，孕酮水平低的妊娠中有81.4%（n = 34/43）分娩活婴，而孕酮水平较高的妊娠中这一比例为91.7%（n = 744/811）（p = 0.0454）。
与孕酮水平较高的妊娠相比，孕酮水平低的妊娠孕囊往往较小，且对于给定的CRL，孕囊小于预期。当前研究表明，妊娠初期孕酮水平低的女性流产风险仍然较高，即使妊娠最初在孕早期被发现是可行的。无论最终结局如何，这些妊娠也往往与超声检查发现孕囊小于给定孕周预期的情况相关。
