Yan Ling, Su Yiming, Liao Zhenhua, Chen Hongqin, Ran Jing
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, 55 Zhenhai Road, Xiamen, 361003, People's Republic of China.
Department of Ultrasound, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, 55 Zhenhai Road, Xiamen, 361003, People's Republic of China.
Sci Rep. 2025 Sep 26;15(1):33010. doi: 10.1038/s41598-025-18390-3.
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).
了解复发性自然流产（RSA）患者妊娠结局的预测因素至关重要。因此，我们旨在确定平均孕囊直径与头臀长度之差（mGSD-CRL）对妊娠6-10周的RSA患者妊娠结局的影响，并探讨其在预测RSA患者妊娠结局中的意义。这项回顾性队列研究纳入了2020年1月至2023年3月期间到我院就诊的256例妊娠6-10周且患有RSA的孕妇。根据mGSD-CRL差值将患者分为三组：A组：mGSD-CRL≤10mm，B组：10mm＜mGSD-CRL≤15mm，C组：mGSD-CRL＞15mm。A组的妊娠失败率为22%，高于B组（5.5%）和C组（9.4%），差异有统计学意义（P＜0.05）。二元逻辑回归分析显示，mGSD（比值比[OR]=1.14，95%置信区间[CI]=1.06-1.23，P=0.001）、CRL（OR=1.16，95%CI=1.05-1.28，P=0.004）和mGSD-CRL（OR=1.12，95%CI=1.01-1.24，P=0.026）是影响RSA患者妊娠结局的独立危险因素。然而，子宫动脉收缩期峰值与舒张末期值之比（UtA-S/D）、D-二聚体（DD）、二磷酸腺苷（ADP）和花生四烯酸（AA）与之无关（P＞0.05）。妊娠6-10周时mGSD-CRL的受试者工作特征（ROC）曲线下面积为0.566，截断值为9.50mm。敏感性和特异性分别为90%和36%。与它们的预测值相比，mGSD-CRL、mGSD和CRL的联合预测在预测妊娠结局方面具有更高的值（AUC=0.718）。检测到ADP与mGSD-CRL差值之间存在弱负相关（r=-0.165，P=0.025）。在RSA患者中，mGSD-CRL是影响妊娠结局的独立危险因素，从而有效预测RSA患者的早期妊娠结局。因此，mGSD-CRL差值低表明流产概率增加，临床医生迫切需要及时关注。试验注册：该研究已在ClinicalTrials.gov注册（试验注册号：NCT06081556，2023年10月13日）。
