PubMed Health⌕ Search

Biomedical subjects

Ganesh Acharya

Publications and source records attributed to Ganesh Acharya.

17 recordsLinked to original sources
PubMed2006

Fetal echocardiography during routine first-trimester screening: a feasibility study in an unselected population.

OBJECTIVE: To evaluate the feasibility of obtaining standard echocardiographic views of the fetal heart during routine first-trimester screening and construct reference ranges for cardiac biometry at 11 + 0 to 13 + 6 weeks of gestation. METHODS: A cross-sectional study of 584 fetuses in an unselected population. Viable pregnancies with a crown-rump length (CRL) of 41-78 mm were included. Echocardiography was performed by a single obstetrician using a 5 to 7.5 MHz vaginal transducer. The course and outcome of pregnancies were recorded and information on the babies was obtained in all cases. RESULTS: A completely satisfactory visualization of the fetal heart structures was possible in 58% (43%, 56% and 62% at 11, 12 and 13 weeks, respectively). Reference ranges were constructed from the measurements of cardiac ventricles, their outflow tracts, and cardiothoracic circumference ratio in relation to CRL. CONCLUSION: Standard echocardiograhic views of the fetal heart can be obtained at 11 + 0 to 13 + 6 weeks of gestation using the transvaginal approach. New reference ranges were established for fetal cardiac biometry at 11 + 0 to 13 + 6 weeks of gestation.

Adolescent↗
PubMed2006

Fetal oxygenation and Doppler ultrasonography of cardiovascular hemodynamics in a chronic near-term sheep model.

OBJECTIVE: We hypothesized that a decrease in fetal oxygenation without acidemia in a near-term fetal sheep leads to cardiovascular hemodynamic changes that are detectable by Doppler ultrasonography. STUDY DESIGN: Twelve ewes and fetuses were instrumented at 112 to 127 days of gestation. After a 5-day recovery period, experiments were performed with general anesthesia. Uterine and placental volume blood flows and fetal arterial and venous blood pressures were measured. Fetal cardiovascular hemodynamics was assessed by Doppler ultrasonography. All the measurements were performed at baseline, during fetal hypo-oxygenation, and at recovery phase. RESULTS: A drop in fetal Po2 was related to increased (P < .05) weight-indexed right ventricular and combined cardiac outputs and proximal branch pulmonary artery pulsatility index values. The increase in proximal branch pulmonary artery pulsatility index values correlated (R = .59; P < .05) with the decrease in fetal oxygen saturation. In the aortic isthmus, the time-velocity integral ratio between antegrade and retrograde blood flow components decreased (P < .05) when fetal Po2 dropped. CONCLUSION: During decreased fetal oxygenation Doppler ultrasonography demonstrated increased fetal cardiac output and pulmonary arterial vascular impedance and a relative increase in the retrograde blood flow component in the aortic isthmus.

Animals↗
PubMed2005

Noninvasive cerclage for the management of cervical incompetence: a prospective study.

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of a noninvasive cerclage pessary in the management of cervical incompetence. METHODS: This is a prospective cohort study of all pregnant women treated for cervical incompetence during a 4-year period. Women with known risk factors for preterm delivery had transvaginal ultrasonography every 2-3 weeks after 17-19 weeks of gestation. Those with progressive shortening of cervix diagnosed before 30 weeks were treated with a cerclage pessary when the cervical length was < or = 25 mm. The pessary was electively removed at 34-36 weeks. The course and outcome of pregnancy were recorded. RESULTS: Thirty-two women were treated with a cerclage pessary. There were nine twin and two triplet pregnancies. Fifteen (47%) had two or more risk factors for preterm delivery. The mean gestational age at cerclage was 23 (17-29) weeks, cervical length 17 (5-25) mm. Two women required delivery before the onset of labor due to severe intrauterine growth restriction and one due to HELLP syndrome. These were excluded from further analysis. In the remaining 29 women, the interval between cerclage and delivery was 10.4 (2-19) weeks, mean gestational age at delivery 34 (22-42) weeks, and birth weight 2,255 (410-4,045) g. Thirteen (45%) women delivered before 34 weeks. There were a total of 35 live-born infants and four intrapartum fetal deaths (all between 22 and 25 weeks gestation). All women complained of increased vaginal discharge, but no other significant complications were observed that could be attributed to the use of pessary. CONCLUSION: Cerclage pessary may be useful in the management of cervical incompetence. Whether it can be a noninvasive alternative to surgical cerclage merits further investigation.

Adult↗
PubMed2005

Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia.

OBJECTIVE: Previous studies have shown conflicting results on the outcome of pregnancy following loop electrosurgical excision procedure (LEEP). The purpose of this study was to evaluate whether LEEP affects the outcome of pregnancy after 20 weeks' gestation. METHODS: This is a matched cohort study of all women who had a LEEP for a biopsy-confirmed cervical intraepithelial neoplasia (CIN) in between December 1995 and December 2000 and subsequently delivered (after 20 weeks' gestation) at the University Hospital of Northern Norway. Women who had an ectopic pregnancy or an abortion (spontaneous or induced) following LEEP were excluded from analysis. Two controls matched for the date of delivery, age, parity, previous obstetric history and smoking habit were identified for each case using routinely entered data from the birth register. The main outcome measures were the duration of pregnancy and birth weight. Other variables recorded included the grade of cervical dysplasia, size of the electrosurgical loop, age, parity, pregnancy complications, mode of delivery, and perinatal outcome. RESULTS: Of a total of 428 women of reproductive age who had LEEP performed during the study period, 89 had a pregnancy after the procedure. Ten women were excluded (three ectopic pregnancies, two induced abortions and five spontaneous abortions) from the study. Data from 79 women whose pregnancies progressed beyond 20 weeks and 158 matched controls were analysed. The mean age at the time of LEEP was 27 (range 19-36) years. The histological diagnosis was normal in 3 (3.8%), CIN1 in 5 (6.3%), CIN2 in 18 (22.8%), and CIN3 in 53 (67.1%) of the cases. Overall, mean gestation at delivery (38.3 vs. 39.1 weeks), mean birth weight (3,412 vs. 3,563 g), prevalence of preterm birth (11.4% vs. 10.8%) and low birth weight (10.1 vs. 5.1%) were not significantly different among the cases and controls. But when a relatively large loop (25 mm) had been used, the risk of preterm delivery (odds ratio 4.0) and low birth weight (odds ratio 14.0) was significantly higher than in controls. Pregnancy complications occurred more frequently (20 vs. 7%; p=0.006) among the cases than the controls. CONCLUSION: LEEP in women with CIN did not significantly increase the risk of low birth weight or preterm birth in subsequent pregnancy in comparison to their controls, except when the size of electrosurgical loop was relatively large. However, the prevalence of pregnancy complications was significantly higher after LEEP.

Adult↗
PubMed2005

Reference ranges for umbilical vein blood flow in the second half of pregnancy based on longitudinal data.

OBJECTIVES: To construct new reference ranges for serial measurements of umbilical vein (UV) blood flow. METHODS: Prospective longitudinal study of blood flow velocities and diameter of the UV measured at four-weekly intervals during 19 to 42 weeks' gestation in 130 low-risk singleton pregnancies. Regression models and multilevel modeling were used to construct the reference ranges. RESULTS: On the basis of 511 sets of longitudinal observations, we established new reference percentiles of UV diameter, blood flow velocities, volume flow, and blood flow normalized for fetal weight and abdominal circumference. They reflected some of the developmental patterns of previous cross-sectional studies, but with important differences, particularly near term. The UV blood flow showed a continuous increase until term, whereas the flow normalized per unit fetal weight, a corresponding reduction. Calculating the blood flow on the basis of intensity-weighted mean velocity or 0.5 of the maximum velocity gave almost interchangeable results for most fetuses. CONCLUSION: New reference ranges for UV blood flow based on longitudinal observations appear slightly different from cross-sectional studies, and should be more appropriate for serial evaluation of fetal circulation.

Adolescent↗
PubMed2005

Reference ranges for serial measurements of umbilical artery Doppler indices in the second half of pregnancy.

OBJECTIVE: The purpose of this study was to construct new reference ranges for serial measurements of commonly used umbilical artery Doppler indices (pulsatility index, resistance index, and systolic:diastolic ratio). STUDY DESIGN: This was a prospective longitudinal study of the umbilical artery Doppler indices that were obtained serially at the free-loop of umbilical cord at 4-week intervals at 19 to 42 weeks of gestation in 130 low-risk singleton pregnancies. A total of 513 observations were used to construct the reference ranges with the use of multilevel modeling. RESULTS: Longitudinally established percentiles of Doppler indices from the present study show a continuous reduction throughout the second half of pregnancy without any plateau or increase near term, as reported previously. There was a significant negative association between Doppler indices and placental weight and neonatal birth weight, but not with gender. The intraobserver coefficients of variation for the umbilical artery pulsatility index, resistance index, and systolic:diastolic ratio were 10.5%, 6.8 %, and 13.0 %, respectively. CONCLUSION: New reference ranges for umbilical artery Doppler indices that are based on longitudinal observations appear to be slightly different from cross-sectional studies and are more appropriate for serial evaluation of fetal hemodynamics.

Adolescent↗
PubMed2005

Catheter-directed thrombolysis for the management of postpartum deep venous thrombosis.

BACKGROUND: Catheter-directed thrombolysis that removes the thrombus and restores patency of the veins appears to be a safe and effective management of acute deep venous thrombosis (DVT). It has been shown to reduce long-term postthrombotic morbidity and improve the quality of life. Pregnancy and the postpartum period are generally considered as contraindications for thrombolysis. However, catheter-directed thrombolytic therapy of DVT may reduce long-term sequelae in these young patients by restoring the patency of veins. The purpose of this pilot study was to evaluate the efficacy of catheter-directed thrombolysis in treating acute symptomatic postpartum DVT. METHODS: Patients enrolled had symptomatic acute DVT (<3 weeks duration) within 42 days of childbirth. Thrombolysis was performed using a recombinant human tissue plasminogen activator, alteplase 5 mg i.v. bolus, followed by an infusion at 0.01 mg/kg/h for the next 20-24 hr. Unfractionated heparin 5000 IU bolus followed by 300 IU/kg/24 hr was infused concomitantly into an arm vein. Fibrinogen and cephotest were obtained every 6 hr and maintained at >1 g/l and between 50 and 70 s, respectively, by adjusting heparin and alteplase infusion. Venography was repeated after 20-24 hr and angioplasty (+/- stenting) was performed if stenosis was present. In case of partial thrombolysis infusion was continued for a maximum of 96 hr. Lysis was considered complete if there was less than 5% residual luminal area narrowing. The treatment was considered successful if there was complete or partial resolution of lower extremity pain and edema, and recanalization of vein with less than 30% residual luminal area narrowing. Following thrombolytic therapy, patients were fitted with graduated compression stockings, and anticoagulated with oral warfarin for 1 year (or lifelong in case of stent implantation). RESULTS: Five women with postpartum DVT (four iliofemoral DVTs, and one renal and ovarian vein thrombosis on the left side) had catheter-directed thrombolysis. The treatment was successful in all four cases of iliofemoral DVT and symptom relief was achieved in all five cases. However, despite partial thrombolysis and restoration of some flow in the patient with renal and ovarian vein thrombosis, the renography performed 1 month later showed absent left kidney function. CONCLUSION: Where expertise exists, endovascular therapy consisting of catheter-directed thrombolysis with angioplasty and stenting in selected cases could be considered as a primary therapeutic procedure in patients with acute postpartum DVT.

Adult↗
PubMed2005

Management of women with epilepsy: Are guidelines being followed? Results from case-note reviews and a patient questionnaire.

PURPOSE: Several international guidelines for the management of women with epilepsy (WWE) have been developed since 1989. We aimed to determine whether guidelines for the management of WWE are followed and whether active implementation of such guidelines makes a difference to clinical practice. METHODS: The study covered a 2-year period of "passive dissemination" of guidelines followed by a 2-year period of "active implementation." Documentation reflecting adherence to the guidelines was abstracted retrospectively from electronic medical records on 215 WWE aged 16-42 years. Data abstracted from case notes included counselling on contraception and pregnancy-related issues; follow-up during pregnancy; advice on supplementation of folic acid, calcium, and vitamin D; and serum folate measurements. A questionnaire assessing the knowledge of WWE issues was completed by 112 (71%) of 157 patients. RESULTS: Documentation that WWE issues had been addressed was found in approximately one third of medical case records with no measurable effect of active implementation. Only the follow-up during pregnancy seemed to have improved. Serum folate measurements in 51 women treated with enzyme-inducing antiepileptic drugs (AEDs) revealed folate deficiency in 11 (22%). Respondents to the questionnaire recalled having received information from their neurologists on the interaction between AEDs and oral contraceptives (46%), need to plan pregnancy (63%), and folic acid requirement (56%). CONCLUSIONS: Judged by a review of documentation in case notes, active implementation of guidelines had no measurable effect on clinical practice. However, the follow-up during pregnancy seemed to have improved. Patients' knowledge of WWE issues compared favorably with published studies. Better strategies are needed to secure successful implementation of guidelines.

Abnormalities, Drug-Induced↗
PubMed2004

The fetal circulation.

Accumulating data on the human fetal circulation shows the similarity to the experimental animal physiology, but with important differences. The human fetus seems to circulate less blood through the placenta, shunt less through the ductus venosus and foramen ovale, but direct more blood through the lungs than the fetal sheep. However, there are substantial individual variations and the pattern changes with gestational age. The normalised umbilical blood flow decreases with gestational age, and, at 28 to 32 weeks, a new level of development seems to be reached. At this stage, the shunting through the ductus venosus and the foramen ovale reaches a minimum, and the flow through the lungs a maximum. The ductus venosus and foramen ovale are functionally closely related and represent an important distributional unit for the venous return. The left portal branch represents a venous watershed, and, similarly, the isthmus aorta an arterial watershed. Thus, the fetal central circulation is a very flexible and adaptive circulatory system. The responses to increased afterload, hypoxaemia and acidaemia in the human fetus are equivalent to those found in animal studies: increased ductus venosus and foramen ovale shunting, increased impedance in the lungs, reduced impedance in the brain, increasingly reversed flow in the aortic isthmus and a more prominent coronary blood flow.

Animals↗
PubMed2004

A randomized controlled trial comparing surgical termination of pregnancy with and without continuous ultrasound guidance.

CONTEXT: Approximately 50 million abortions are performed worldwide each year, and the majority of them are surgical terminations of pregnancy (STOP). Therefore, the safety of this procedure is a global public health concern. It is not known whether routine use of intraoperative ultrasound guidance improves the outcome of first trimester STOP. OBJECTIVE: To investigate whether surgical termination of pregnancy in the first trimester with continuous ultrasound guidance is safer than the conventional procedure without ultrasound guidance. DESIGN: A randomized controlled trial. SETTING: A teaching hospital in London, UK. PARTICIPANTS: Women undergoing STOP in the first trimester. INTERVENTION: PARTICIPANTS were randomized to have the procedure with or without continuous ultrasound guidance. OUTCOME MEASURES: The primary outcome measures were intraoperative and short-term complications (anaesthetic complication, haemorrhage, ongoing pregnancy, cervical trauma, uterine perforation, need for laparoscopy and/or laparotomy, repeat evacuation, and infection). The secondary outcomes were the blood loss, procedure time, and convalescence time. RESULTS: A total of 230 women (115 in each arm of the trial) participated in the study. Follow-up data were available for analysis in all but 15 (8 in control group and 7 in intervention group) cases. Baseline characteristics were similar in both groups. The overall complication rate was 9.8 percent. STOP under ultrasound guidance had a complication rate of 3.7% (4/108) in comparison to 15.9% (17/107) without ultrasound (RR 0.23, 95% CI 0.08-0.67). Intraoperative ultrasound guidance also had a statistically significant beneficial effect in reducing the blood loss, procedure time, and convalescence time. CONCLUSION: STOP in the first trimester under continuous ultrasound guidance was associated with a lower rate of complications than the conventional procedure without ultrasound.

Abortion, Induced↗
PubMed2004

Role of routine ultrasonography in monitoring the outcome of medical abortion in a clinical setting.

BACKGROUND: Clinical methods generally used to evaluate the completeness of medical abortion are not accurate. There are no published reports evaluating the role of routine ultrasonography in monitoring the outcome of medical abortion. The purpose of this study was to investigate whether routine transvaginal ultrasonography (TVS) at the follow-up visit after medical abortion can accurately identify women who will require surgical intervention. DESIGN: Retrospective review of medical records and charts of all women undergoing medical abortion in the first trimester of pregnancy between January 1999 and December 2001. METHODS: Medical abortion was performed using oral mifepristone and a vaginal prostaglandin analog before 63 days gestation. All women had an initial TVS to confirm intrauterine pregnancy and gestational age, and another TVS at the follow-up visit 2-3 weeks later to assess the completeness of abortion. Surgical evacuation of the uterus was allowed as indicated on clinical grounds but not on the basis of ultrasound findings only. RESULTS: A total of 690 women consented to medical abortion during the study period. Eleven of these women were excluded from the study for various reasons. Of the remaining 679 cases, 95% (645/679) had a documented follow-up at the hospital. The pregnancy termination rate among these women was 99.2% (640/645) and TVS identified all five cases of continuing pregnancy at the follow-up. A total of 66 (10.2%) patients had complications. The uterine cavity was empty on TVS at the follow-up visit in 84.8% (547/645) of cases and only 3.1% (17/547) of them required surgical aspiration/curettage due to excessive or prolonged vaginal bleeding. In the remaining 15.2% (98/645) the uterine cavity was not empty, and 43.9% (43/98) of them had a curettage. The risk of requiring a surgical intervention was significantly higher [odds ratio (OR) 24.4; 95% confidence interval (95% CI) 14.9-39.7] when the uterine cavity was not demonstrated to be empty at the follow-up visit 2-3 weeks after medical abortion. However, 59.1% (55/93) of women did not require surgical intervention despite ultrasound evidence of thick endometrial echo-complex. CONCLUSION: Routine TVS 2-3 weeks after medical abortion appears to be an efficient means of accurately identifying the cases of ongoing pregnancy and diagnosing a complete abortion. Although TVS could be used as an adjunct to clinical examination to diagnose an incomplete expulsion, it does not accurately differentiate those women who require surgical intervention from those who do not.

Abortifacient Agents, Steroidal↗
PubMed2004

Major congenital heart disease in Northern Norway: shortcomings of pre- and postnatal diagnosis.

BACKGROUND: Congenital heart disease (CHD) is a significant cause of perinatal mortality and morbidity worldwide. Prenatal detection rate of CHD remains low in most European countries and a substantial proportion of infants with serious heart disease are diagnosed only after discharge from hospital after birth. Earlier recognition of treatable abnormalities may improve the perinatal outcome. The purpose of this study was to evaluate the incidence, pre- and postnatal diagnosis and outcome of major CHD in two northern-most counties of Norway. MATERIALS AND METHODS: All cases of major CHD were identified by reviewing the records of all fetal and neonatal echocardiographies and all perinatal autopsies performed during the study period. Data were obtained on maternal age, associated risk factors, time of diagnosis, type of CHD and outcome. RESULTS: Ninety-one fetal and 52 neonatal echocardiographies and 77 perinatal autopsies were performed during the 2-year study period. There was a total of 5658 births during this period. Twenty-five cases of major CHD were identified. Six of them were diagnosed prenatally, 18 after birth, and one additional case was identified from the perinatal autopsy register. The incidence of major CHD in Northern Norway was 4.4 per 1000 births. The prenatal detection rate was 24% (6/25). In 39% (7/18) of cases diagnosed postnatally the diagnosis was made following a second admission after the baby has been initially discharged from hospital after birth. The mortality among liveborn infants with major CHD was 17.4% (4/23). CONCLUSION: Despite almost universal prenatal ultrasound screening and at least one neonatal examination before discharge, the diagnosis of major CHD is made after a relevant delay in a substantial proportion of cases.

Adult↗
PubMed2004

Endogenous sex hormones in relation to age, sex, lifestyle factors, and chronic diseases in a general population: the Tromsø Study.

The role played by endogenous hormones in many diseases makes it important to understand factors influencing their levels. This study examined the distribution of total and free estradiol, FSH, and dehydroepiandrosterone sulfate (DHEAS) by age and sex and associations of these hormones with body mass index (BMI), lifestyle factors, and chronic diseases. Plasma samples taken from 1555 men and 1952 women 25-84 yr of age in 1994-1995 Tromsø Study were analyzed in 2001. Total estradiol increased with age among men (P < 0.001), with or without adjustment for BMI and lifestyle factors. FSH increased with age both in men (P < 0.001) as well as pre- (P < 0.001) and postmenopausal women (P = 0.01) after similar adjustment, and DHEAS decreased with age in both sexes (P < 0.001). With increasing BMI, free estradiol increased in men (P = 0.004), total and free estradiol increased in postmenopausal women (P < 0.001), and FSH decreased in men (P = 0.03) and postmenopausal women (P < 0.001). Men with chronic diseases had lower levels of DHEAS, compared with healthy men (P < 0.001). Smokers had higher DHEAS levels than nonsmokers. Further studies are needed to confirm these hormonal changes with age and disease.

Adult↗
PubMed2003

Relationships among Doppler-derived umbilical artery absolute velocities, cardiac function, and placental volume blood flow and resistance in fetal sheep.

We hypothesized that umbilical artery (UA) absolute blood flow velocities measured by Doppler ultrasonography reflect placental volume blood flow (Q(UA)) and placental vascular resistance (R(UA)) in a late gestation fetal sheep model. In addition, we examined the relationships between umbilical artery absolute blood flow velocities and parameters of fetal cardiac function. Twenty-six sheep fetuses were instrumented at 112-132 days of gestation. After a 5-day recovery period, experiments were performed under general anesthesia in 16 normal fetuses, in 5 fetuses after maternal administration of phenylephrine, and in 5 fetuses after placental embolization. The Q(UA) and arterial blood pressures were measured using a transit-time ultrasonic flow probe and a catheter placed into the descending aorta, respectively. UA peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (TAMXV), pulsatility index (PI), mean velocity (V(mean)), fetal cardiac output, ventricular ejection forces, and the proportion of isovolumetric relaxation time (IRT%) in the cardiac cycle were measured with the use of Doppler ultrasonography. Significant positive linear correlations were found between UA EDV, TAMXV, and V(mean) versus Q(UA), whereas UA PI had a significant negative correlation with Q(UA). Significant negative correlations were shown between UA EDV, TAMXV, and V(mean) versus R(UA). A significant positive correlation was present between UA PI and R(UA). Doppler-derived UA parameters did not correlate with fetal arterial blood pressures, cardiac output, ventricular ejection forces or IRT%. In fetal sheep, Doppler-derived UA PI and absolute velocities, except PSV, are closely related to directly measured Q(UA) and R(UA), validating the use of noninvasive Doppler velocimetry in the assessment of placental circulation.

Anesthesia↗
PubMed2002

[Postpartum hemorrhage--prophylaxis and treatment in Norway].

BACKGROUND: Routine oxytocic prophylaxis is known to significantly reduce the risk of severe postpartum haemorrhage (> 1,000 ml) and need for blood transfusion after delivery. To what extent this evidence is implemented in clinical practice in Norway is not known. MATERIAL AND METHODS: A telephone questionnaire survey was carried out in September 2001 to evaluate the routine clinical practice for prevention and treatment of postpartum haemorrhage in Norwegian delivery units. RESULTS: Data were available for 55 out of 57 institutions with a delivery unit. Routine third stage prophylaxis with 5-10 IU oxytocin was practiced in 47% of delivery units. Intravenous oxytocin infusion was used primarily in all the delivery units for the treatment of established primary postpartum haemorrhage. 74% of units used methylergometrine, 21% misoprostol as the second-line treatment. INTERPRETATION: Despite evidence for the use of oxytocics for the prevention of postpartum haemorrhage, less than half of delivery units in Norway practice routine prophylaxis in the third stage of labour. Norwegian women may benefit if all maternity care providers implement evidence-based practice.

Carboprost↗
PubMedDate not supplied

Does gestational sac volume predict the outcome of missed miscarriage managed expectantly?

PURPOSE: The aim of this study was to investigate whether gestational sac volume (GSV) can predict the outcome of missed miscarriages that are managed expectantly. METHODS: This was a prospective observational study. Between February 1, 2000, and January 31, 2001, all patients with a confirmed first-trimester missed miscarriage who chose to undergo expectant management were recruited to participate. A single investigator performed all sonographic examinations and measurements. The main outcome measure was a complete spontaneous abortion within 4 weeks of the initial diagnosis. A complete miscarriage was defined as a maximum anteroposterior diameter of the endometrium of less than 15 mm on transvaginal sonography and no persistent heavy vaginal bleeding. The patients could opt to undergo surgery at any time, but those who had not expelled the products of conception within 4 weeks of the diagnosis were advised to have surgical uterine evacuation. RESULTS: In total, 90 patients were enrolled, and 86 patients completed the study. The mean GSV, as measured by 3-dimensional sonography, was 9.7 +/- 8.9 ml, and the mean sac diameter was 24.5 +/- 8.0 mm. A significant exponential correlation was found between the mean sac diameter and the GSV (r = 0.86; p < 0.0001). Forty-six (53.5%) of the 86 patients experienced a complete miscarriage within 4 weeks of the diagnosis (ie, expectant management was successful), but expectant management was unsuccessful in the remaining 40 (46.5%) patients (5 had an incomplete miscarriage, and 35 did not expel the products of conception). The GSV did not differ significantly between the "successful" and "unsuccessful" groups (p = 0.82). A logistic regression analysis showed no significant correlation between GSV and the outcome of missed miscarriages managed expectantly (p = 0.59). CONCLUSIONS: The GSV does not predict the outcome of expectant management of missed miscarriage within 4 weeks of the diagnosis.

Abortion, Missed↗