Novel early first trimester ultrasound measures in the prediction of miscarriage, small-for-gestational age neonates and maternal hypertensive disorders

Abstract

One of the primary roles of obstetric care is the prediction of adverse fetal and maternal outcomes. Ultrasound is commonly used prior to 11 weeks gestation however there is a paucity of published research investigating the value of ultrasound features at this early stage in the prediction of adverse fetal and maternal outcomes later in pregnancy. Adverse pregnancy outcomes of small-for-gestational age/intrauterine growth restriction and maternal hypertensive disorders (gestational hypertension and pre-eclampsia) are significant pregnancy complications that often result in poor short- and long-term outcomes for both child and mother. Early prediction coupled with prophylactic intervention has been demonstrated to reduce the prevalence of these outcomes. First trimester miscarriage is common, and while its prediction may not influence the outcome, ultrasound is uniquely situated to significantly impact the clinical management of these women. The research presented in this thesis investigates the potential for a combination of conventional and novel ultrasound measures prior to 11 weeks gestation to predict adverse pregnancy outcomes including miscarriage prior to 12 weeks gestation and the development of small-for-gestational age and maternal hypertensive disorders later in pregnancy. We found that when measured prior to 11 weeks gestation, less than expected trophoblast volume for gestational age is significantly associated with all three adverse outcomes of interest. In addition, together with maternal characteristics and biochemistry, trophoblast volume measurements may add to the value of current prediction methods for small-for-gestational age and maternal hypertensive disorders and may enable prediction at an earlier gestational age.