First-Trimester Prognosis When an Early Gestational Sac is Seen on Ultrasound Imaging: Logistic Regression Prediction...

Area of Science:

• Reproductive Medicine
• Early Pregnancy Diagnostics
• Clinical Prediction Modeling

Background:

• Very early intrauterine pregnancies, defined by a gestational sac without a visible yolk sac or embryo, present diagnostic challenges.
• Accurate prediction of first-trimester outcomes for these pregnancies is crucial for patient management and counseling.

Purpose of the Study:

• To identify clinical, biochemical, and sonographic factors influencing the outcome of very early intrauterine pregnancies.
• To develop a predictive mathematical model and a web-based calculator for assessing pregnancy prognosis.

Main Methods:

• A retrospective analysis of 590 very early pregnancies with known outcomes.
• Data collected included patient age, mean sac diameter (MSD), human chorionic gonadotropin (hCG) rise, vaginal bleeding, history of infertility, prior miscarriage, and assisted reproductive technology (ART) use.
• Stepwise logistic regression was employed to identify independent predictors of outcome.

Main Results:

• Patient age, MSD, hCG rise, and vaginal bleeding were independently correlated with first-trimester pregnancy outcome (P < .05).
• The logistic regression model demonstrated good predictive accuracy, with an area under the receiver operating characteristic curve of 0.823.
• A web-based calculator was developed using these four key variables to predict pregnancy outcomes.

Conclusions:

• The first-trimester prognosis of very early intrauterine pregnancies is multifactorial, influenced by patient age, MSD, hCG rise, and vaginal bleeding.
• These identified factors provide a robust basis for a predictive model to estimate pregnancy outcomes.
• The developed web-based calculator offers a practical tool for clinicians to assess prognosis in early pregnancy.