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Cited by 41Prenatal Screening and DiagnosticsReproductive System and PregnancyReproductive Health and Contraception

Prediction of miscarriage in women with viable intrauterine pregnancy—A systematic review and diagnostic accuracy meta-analysis

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Pillai, Rekha N., Konje, Justin C., Richardson, Matthew, Tincello, Douglas G., Potdar, Neelam·2018·European Journal of Obstetrics & Gynecology and Reproductive Biology
DOI 10.1016/j.ejogrb.2017.10.024
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Abstract

Both ultrasound and biochemical markers either alone or in combination have been described in the literature for the prediction of miscarriage. We performed this systematic review and meta-analysis to determine the best combination of biochemical, ultrasound and demographic markers to predict miscarriage in women with viable intrauterine pregnancy. The electronic database search included Medline (1946-June 2017), Embase (1980-June 2017), CINAHL (1981-June 2017) and Cochrane library. Key MESH and Boolean terms were used for the search. Data extraction and collection was performed based on the eligibility criteria by two authors independently. Quality assessment of the individual studies was done using QUADAS 2 (Quality Assessment for Diagnostic Accuracy Studies-2: A Revised Tool) and statistical analysis performed using the Cochrane systematic review manager 5.3 and STATA vs.13.0. Due to the diversity of the combinations used for prediction in the included papers it was not possible to perform a meta-analysis on combination markers. Therefore, we proceeded to perform a meta-analysis on ultrasound markers alone to determine the best marker that can help to improve the diagnostic accuracy of predicting miscarriage in women with viable intrauterine pregnancy. The systematic review identified 18 eligible studies for the quantitative meta-analysis with a total of 5584 women. Among the ultrasound scan markers, fetal bradycardia (n=10 studies, n=1762 women) on hierarchical summary receiver operating characteristic showed sensitivity of 68.41%, specificity of 97.84%, positive likelihood ratio of 31.73 (indicating a large effect on increasing the probability of predicting miscarriage) and negative likelihood ratio of 0.32. In studies for women with threatened miscarriage (n=5 studies, n=771 women) fetal bradycardia showed further increase in sensitivity (84.18%) for miscarriage prediction. Although there is gestational age dependent variation in the fetal heart rate, a plot of fetal heart rate cut off level versus log diagnostic odds ratio showed that at ≤110 beat per minutes the diagnostic power to predict miscarriage is higher. Other markers of intra uterine hematoma, crown rump length and yolk sac had significantly decreased predictive value. Therefore in women with threatened miscarriage and presence of fetal bradycardia on ultrasound scan, there is a role for offering repeat ultrasound scan in a week to ten days interval.

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Authors
Pillai, R. N., Konje, J. C., Richardson, M., Tincello, D. G., & Potdar, N.
Affiliations
  • University of Leicester (GB)
  • Sidra Medical and Research Center (QA)
  • University Hospitals of Leicester NHS Trust (GB)
Corresponding author
Potdar, Neelam
ORCID
Venue
European Journal of Obstetrics & Gynecology and Reproductive Biology
Publisher
Elsevier BV
Published
2018-01
Volume
220
Pages
122-131
ISSN
  • 0028-2243 (ISSN-L)
  • 0301-2115
DOI
10.1016/j.ejogrb.2017.10.024
OpenAlex
W2765244922
Cited by
41
References
40
Citations by year
2026: 2 · 2025: 5 · 2024: 8 · 2023: 4 · 2022: 6 · 2021: 2 · 2020: 7 · 2019: 4 · 2018: 3
FWCI
0.72
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Obstetrics & Gynecology and Reproductive Biology (publishedVersion)
  • PubMed (publishedVersion)
  • Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Screening and Diagnostics
  • Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
miscarriage prediction, threatened abortion, fetal bradycardia, ultrasound markers, biochemical markers, diagnostic accuracy, crown-rump length, yolk sac, gestational age
MeSH terms
Abortion, Spontaneous, Female, Humans, Maternal Age, Predictive Value of Tests, Pregnancy, Pregnancy Trimester, First, Sensitivity and Specificity, Ultrasonography, Prenatal, Crown-Rump Length

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