BACKGROUND: Subchorionic hematoma (SCH) is a common complication in early pregnancy characterized by the accumulation of blood between the uterine wall and the chorionic membrane. SCH can lead to adverse pregnancy outcomes such as miscarriage, preterm birth, and other complications. Early detection and accurate assessment of SCH are crucial for appropriate management and improved pregnancy outcomes.
OBJECTIVE: To evaluate the diagnostic efficacy of virtual organ computer-assisted analysis (VOCAL) in measuring the volume ratio of SCH to gestational sac (GS) combined with serum progesterone on early pregnancy outcomes in patients with SCH.
METHODS: A total of 153 patients with SCH in their first-trimester pregnancies between 6 and 11 wk were enrolled. All patients were followed up until a gestational age of 20 wk. The parameters of transvaginal two-dimensional ultrasound, including the circumference of SCH (Cs), surface area of SCH (Ss), circumference of GS (Cg), and surface area of GS (Sg), and the parameters of VOCAL with transvaginal three-dimensional ultrasound, including the three-dimensional volume of SCH (3DVs) and GS (3DVg), were recorded. The size of the SCH and its ratio to the GS size (Cs/Cg, Ss/Sg, 3DVs/3DVg) were recorded and compared.
RESULTS: Compared with those in the normal pregnancy group, the adverse pregnancy group had higher Cs/Cg, Ss/Sg, and 3DVs/3DVg ratios (P < 0.05). When 3DVs/3DVg was 0.220, the highest predictive performance predicted adverse pregnancy outcomes, resulting in an AUC of 0.767, and the sensitivity, specificity were 70.2%, 75% respectively. VOCAL measuring 3DVs/3DVg combined with serum progesterone gave a diagnostic AUC of 0.824 for early pregnancy outcome in SCH patients, with a high sensitivity of 82.1% and a specificity of 72.1%, which showed a significant difference between AUC.
CONCLUSIONS: VOCAL-measured 3DVs/3DVg effectively quantifies the severity of SCH, while combined serum progesterone better predicts adverse pregnancy outcomes.

Our primary objective is to verify or refute a 2013 study by Connolly et al. which showed that in early pregnancy, a gestational sac was visualized 99% of the time on transvaginal ultrasound when the HCG level reached 3510 mIU/mL. Our secondary objective was to make clinical correlations by assessing the relationship between human chorionic gonadotropin (HCG) level in early pregnancy when a gestational sac is not seen and pregnancy outcomes of live birth, spontaneous abortion, and ectopic pregnancy. This retrospective study includes 144 pregnancies with an outcome of live birth, 87 pregnancies with an outcome of spontaneous abortion, and 59 ectopic pregnancies. Logistic regression is used to determine the probability of visualizing a gestational sac and/or yolk sac based on the HCG level. A gestational sac is predicted to be visualized 50% of the time at an HCG level of 979 mIU/mL, 90% at 2421 mIU/mL, and 99% of the time at 3994 mIU/mL. A yolk sac was predicted to be visualized 50% of the time at an HCG level of 4626 mIU/mL, 90% at 12,892 mIU/mL, and 99% at 39,454 mIU/mL. A total of 90% of ectopic pregnancies presented with an HCG level below 3994 mIU/mL. These results are in agreement with the study by Connolly et al. Since most early ectopic pregnancies had an HCG value below the discriminatory level for gestational sac visualization, other methods for the evaluation of pregnancy of unknown location such as repeat HCG values are clinically important.

OBJECTIVE: To explore the risk factors including the difference between mean gestational sac diameter and crown-rump length for missed abortion.
METHODS: Hospitalized patients with missed abortion and patients with continuing pregnancy to the second trimester from Chengdu Women\'s and Children\'s Central Hospital from June 2018 to June 2021 were retrospectively analyzed. The best cut-off value for age and difference between mean gestational sac diameter and crown-rump length (mGSD-CRL) were obtained by x-tile software. Univariate and multivariate logistic regression analysis were adopted to identify the possible risk factors for missed abortion.
RESULTS: Age, gravidity, parity, history of cesarean section, history of recurrent abortion (≥ 3 spontaneous abortions), history of ectopic pregnancy and overweight or obesity (BMI > 24 kg/m2) were related to missed abortion in univariate analysis. However, only age (≥ 30 vs < 30 years: OR = 1.683, 95%CI = 1.017-2.785, P = 0.043, power = 54.4%), BMI (> 24 vs ≤ 24 kg/m2: OR = 2.073, 95%CI = 1.056-4.068, P = 0.034, power = 81.3%) and mGSD-CRL (> 20.0vs ≤ 11.7 mm: OR = 2.960, 95% CI = 1.397-6.273, P = 0.005, power = 98.9%; 11.7 < mGSD-CRL ≤ 20.0vs > 20.0 mm: OR = 0.341, 95%CI = 0.172-0.676, P = 0.002, power = 84.8%) were identified as independent risk factors for missed abortion in multivariate analysis.
CONCLUSIONS: Patients with age ≥ 30 years, BMI > 24 kg/m2 or mGSD-CRL > 20 mm had increasing risk for missed abortion, who should be more closely monitored and facilitated with necessary interventions at first trimester or even before conception to reduce the occurrence of missed abortion to have better clinical outcomes.

OBJECTIVE: To retrospectively evaluate the diagnostic value of MRI for the uterotubal junctional pregnancies during the first trimester.
METHODS: This retrospective study involved 59 patients (January 2016 to July 2021) with a preoperative imaging diagnosis of uterotubal junctional pregnancy. Using operative and pathological reports as the reference standard, we identified 22 patients with upper-lateral intracavitary (angular) pregnancy and 37 patients with interstitial pregnancy. Two senior radiologists, blinded to the patients\' information, reviewed the MRI images and determined each MRI feature based on the original interpretation criteria. Any disagreement was resolved by discussion to achieve a consensus. The sensitivity and specificity of each MRI feature were calculated according to the reference standard.
RESULTS: The endometrial thickness in the upper-lateral intracavitary pregnancy group was larger than in the interstitial group (p = 0.001). The cutoff value of the endometrial thickness was 11.5 mm with a sensitivity, specificity, and area under the curve that were 77.3%, 64.9%, and 0.743, respectively. Two key features to diagnose upper-lateral intracavitary pregnancy were \"medial free edge\" and \"medial free edge plus above-cutoff endometrial thickness.\" The sensitivity and specificity of the medial free edge were 100% and 94.9%, respectively. The sensitivity and specificity of the medial free edge plus above-cutoff endometrial thickness were 77.3% and 100%, respectively. The key feature to diagnose interstitial pregnancy was an \"intact lateral junctional zone,\" of which the sensitivity and specificity were 94.6% and 100%, respectively.
CONCLUSIONS: MRI can be used to differentiate the upper-lateral intracavitary pregnancy and interstitial pregnancy during the first trimester.
CONCLUSIONS: • We demonstrated MRI diagnostic criteria for the interstitial pregnancy and upper-lateral intracavitary pregnancy. • MRI might be used to identify the complex interstitial pregnancies, those with a gestational sac protruding into the uterine cavity.

UNASSIGNED: Early gestational age (GA) assessment using ultrasound is a routine and frequent examination performed in hospitals whereby clinicians manually measure the size of the gestational sac using ultrasound and calculate GA. However, the error is often substantial, and the process is laborious. To overcome these challenges, we propose a new system to assess early GA using a new end-to-end computer vision system and a new biometric measurement method based on ultrasound video.
UNASSIGNED: In this retrospective study, a new system was provided. B-ultrasound videos were first decomposed into two-dimensional (2D) images, and the contours of the gestational sac were extracted and drawn. The maximum length and short diameter of the gestational sac were then automatically measured and GA was calculated using the Hellman formula. Finally, through human-machine comparison, the clinicians\' assessment errors were analyzed by SPSS 26.
UNASSIGNED: In this study, 29,829 2D images of 191 B-ultrasound videos were evaluated using the new system. Clinicians usually require 15-20 min to complete assessments of GA, whereas with the new system assessments can be completed in approximately 30 s. Moreover, a human-machine comparison showed that the system helped intermediate skills clinicians improve their relative diagnostic error by 13.45% with an absolute error of 7 days. In addition, the new system was used to identify other lesions in the uterus and measure their size as a \"sanity check\".
UNASSIGNED: The proposed new system is a practical, reproducible, and reliable approach for assessing early GA.

Ectopic pregnancy is a pregnancy outside the uterine cavity and is, in majority of cases, a non-viable pregnancy. There are multiple methods of managing patients with ectopic pregnancy including expectant, medical and surgical management. Live tubal ectopic pregnancies, also known as ectopic pregnancies present in the fallopian tube with fetal heartbeat still present, are most commonly treated via surgical route. This case outlines the presentation and an unusual method of management of a patient diagnosed with a live tubal ectopic pregnancy with extensive medical and surgical history.

BACKGROUND: Cesarean section scar ectopic pregnancy (CSEP) is a rare and potentially life-threatening condition. A standardized management protocol is yet to be established owing to limited data available.
METHODS: In this paper, five cases of CSEP over a period of 18 months at a tertiary referral hospital, managed medically with methotrexate administered both systemically and into the gestational sac at the time of feticide with potassium chloride (KCL) are presented. Surgical management was the second line therapy when medical treatment failed.
CONCLUSIONS: With rising trends in cesarean deliveries, CSEP may be a challenge which requires close investigation regarding its diagnosis and treatment on the merits of case studies and available healthcare facilities.

The objective of the research study is to investigate the use of three-dimensional ultrasonic measurement technology, to determine the size of gestational sac and embryo volume, and to use the ratio of gestational sac volume to embryo volume in IoT-based prediction of pregnancy outcome. The abnormal and normal pregnancy identifiers are there, which assists in prediction of pregnancy outcomes: whether the pregnancy is normal or may suffer pregnancy loss during first trimester. For the observational study, 500 singleton pregnant women who made an appointment for delivery in Qiqihar Hospital from January 2015 to June 2019 were considered. The 500 pregnant women received transvaginal ultrasound at 6+0 ∼ 8+0 weeks of gestational age to measure gestational sac volume (GSV), yolk sac volume (YSV), and germ volume (GV). According to pregnancy outcome, they were divided into fine group (n = 435) and abortion group (n = 65). Among the 500 cases, 435 had normal delivery and 65 had abortions. According to the results of gestational age (GA) analysis, the pregnancy success rates at 6 (n = 268), 7 (n = 184), and 8 weeks (n = 48) were 85.8%, 87.5%, and 91.7%, respectively. Comparison of pregnancy failure rate among the three groups shows statistically significant difference. The morphology of germ, yolk sac, and gestational sac cannot be used as a predictor of pregnancy outcome in various degrees. The results of multivariate Cox proportional regression analysis show the following: the ratio of germ volume (GV) to gestational sac volume (GSV) (P=0.008) has an impact on the prediction of spontaneous abortion prognosis, showing statistically significant difference; yolk sac volume (YSV), germ volume (GV), and gestational sac volume (GSV) have no effect on the prediction of spontaneous abortion prognosis (P > 0.05). The ratio of GSV to germ volume has a strong prognostic value for pregnancy results. To a certain extent, the ratio of gestational sac volume to germ volume can predict spontaneous pregnancy abortion at 6th week of gestation, providing a theoretical basis for clinical ultrasound pregnancy examination indicators.

Objectives: Early fetal demise (absence of cardiac activity in a visible fetus) is a very common event, but there are no reliable biomarkers to predict it. The purpose of the study was to assess the association of platelet parameters with early fetal demise.Methods: In this case-control study, we included women with normal deliveries or those ultrasound diagnosed as early fetal demise. For those who were identified with early fetal demise, the platelet parameters were analyzed before the ultrasound diagnosis, which is based on the absence of either an embryo within a gestational sac or cardiac activity in a visible embryo in the 5-10 weeks of gestation. The association between the risk of early fetal demise with the women\'s mean platelet volume (MPV) and platelet counts was calculated by logistic regression. Duplicate measurements of platelet aggregation were performed with VerifyNow. Results: In total, 99 women identified with early fetal demise and 170 women who had an uncomplicated pregnancy with normal delivery from January 2017 and August 2020 were included in the study. We found that platelet counts in the early fetal demise group were significantly higher than healthy pregnancies. In addition, platelet reactivity is higher in the normal delivery group than those in early fetal demise group (p < .05). High levels of platelet counts resulted in an adjusted odds ratio (OR) of 2.075 (95% confidence interval [95% CI], 1.215-3.544; p = .008) for early fetal demise. Conclusions: Increased platelet counts in the first trimester may be a predictor for the risk of early fetal demise.

OBJECTIVE: To retrospectively investigate cesarean scar pregnancy (CSP) patients who received systemic methotrexate (MTX) and to clarify the criteria for administering systemic MTX to CSP patients.
METHODS: Fifteen CSP patients who were initially treated with systemic MTX (50 mg/m2/week) were included. Nine patients, who needed a uterine artery embolization (UAE) or a laparotomy, including a transabdominal hysterectomy (TAH), were defined as the unsuccessful MTX group. Six patients who did not require UAE or a laparotomy were defined as the successful MTX group. Furthermore, the hCG cut-off value and the GS cut-off size at the time of CSP diagnosis, which differentiated successful and unsuccessful patients, were defined. MTX success rates were investigated by combining the hCG and gestational sac (GS) size cut-off values.
RESULTS: The hCG cut-off value was 17757.0 mIU/mL, and the GS cut-off size was 10.4 mm. In patients with hCG values less than 17757.0 mIU/mL, the MTX success rate was 75.0%. Fewer patients needed UAE or a laparotomy compared to patients with hCG values higher than 17757.0 mIU/mL (P = 0.007). In patients with a GS size less than 10.4 mm, the MTX success rate was 80.0%. Fewer patients among them needed UAE or a laparotomy compared to those among patients with a GS size greater than 10.4 mm (P = 0.089). In patients with hCG values and GS sizes lower than the cut-off values, the MTX success rate was 80.0%. Fewer patients among them needed UAE or a laparotomy compared to those among patients with hCG values and/or GS sizes higher than the cut-off values, respectively (P = 0.010).
CONCLUSIONS: Patients with hCG values less than 17757.0 mIU/mL and GS sizes less than 10.4 mm may have a greater chance of successful systemic MTX treatment when it is used as the first line of treatment for CSP.