Abdullahi Idle Salwa, Ferrara Laura, Vasireddy Archana, Andersen Katherine, Johns Jemma, Barrett James, Ross Jackie A
School of Medical Education, King's College London, London, UK.
King's College London, London, UK.
Ultrasound. 2024 Nov;32(4):236-242. doi: 10.1177/1742271X231225077. Epub 2024 Mar 10.
The aim of this article is to assess any association between the risk of miscarriage and the distance of an early pregnancy from the closest tubal ostia.
Early pregnancy was defined as a gestational sac ⩽ 15 mm mean diameter within the upper half of the endometrial cavity. The shortest distance from the gestational sac (chorionic membrane) to the closest tubal ostia and the interostial distance were measured. The outcomes for pregnancies at varying distances from a tubal ostia were compared using Fisher's exact test. The receiver operating characteristic curve assessed the distance from the sac to the ostia as a predictor of miscarriage. A Wilcoxon rank-sum test was used to assess any difference in the distance from the ostia between women who miscarried and those who did not.
Outcome data were available for 212/230 patients. The relative risk of miscarriage was 5/6 (83%) in the group with gestational sacs ⩽ 4 mm from the ostium versus 70/206 (34%) > 4 mm ( = 0.02). The proportion of miscarriages was 11/20 (55%) if the distance from the tubal ostium was ⩽5 mm versus 64/192 (33%) if >5 mm ( = 0.08). There was a good neonatal outcome for those with live births.
The risk of first trimester miscarriage was high with early pregnancies implanted close to the tubal ostia, but this finding did not reach statistical significance. A larger study is needed to establish whether 4 or 5 mm could be used as a clinically useful criterion for defining early pregnancies that are at increased risk of miscarriage.
本文旨在评估流产风险与早期妊娠距最近输卵管开口的距离之间是否存在关联。
早期妊娠定义为子宫内膜腔内上半部分平均直径≤15 mm的妊娠囊。测量妊娠囊（绒毛膜）到最近输卵管开口的最短距离以及开口间距离。使用Fisher精确检验比较距输卵管开口不同距离的妊娠结局。采用受试者工作特征曲线评估妊娠囊到开口的距离作为流产预测指标的情况。使用Wilcoxon秩和检验评估流产妇女与未流产妇女距开口的距离是否存在差异。
230例患者中有212例可获得结局数据。妊娠囊距开口≤4 mm组的流产相对风险为5/6（83%），而>4 mm组为70/206（34%）（P = 0.02）。距输卵管开口≤5 mm时流产比例为11/20（55%），而>5 mm时为64/192（33%）（P = 0.08）。活产者新生儿结局良好。
早期妊娠着床于靠近输卵管开口处时，孕早期流产风险较高，但这一发现未达到统计学显著性。需要进行更大规模的研究来确定4或5 mm是否可作为定义流产风险增加的早期妊娠的临床有用标准。
