Prediction of miscarriage in women with threatened miscarriage using a combination of biochemical and ultrasound scan markers - A prospective cohort study

Background: Studies have been previously conducted to investigate biomarkers and ultrasound markers to predict miscarriage in women with threatened miscarriage with varying results. This project reviewed the existing literature and conducted a prospective study to investigate the role of various markers to predict miscarriage in women with threatened miscarriage and develop a prediction model.Methodology: Three systematic review and meta-analysis were conducted to investigate the role of biomarkers and ultrasound markers to predict miscarriage in women with threatened miscarriage and to investigate the perinatal outcomes in them. Subsequently, a prospective cohort study was conducted (N=296) including women presenting with bleeding and/or pain and had a confirmed fetal heartbeat from 6+0 to 11+6 weeks of gestation. An extensive exclusion criterion was used.Results: Comparison of the miscarried women and those who continued pregnancy had shown that, the two groups of women were different in their bleeding score (P-value 0.03), hCG (P-value 0.04), progesterone (P-value 0.03), inhibin A (P-value 0.02), MGSD (P-value 0.04), CRL (P-value 0.03) and FHR (P-value 0.01) . A regression model composed of the variables of age, hCG, inhibin and FHR gave the best sensitivity (57%) and specificity (96%) to predict miscarriage (P-value 0.0003); diagnostic odds ratio (95% CI) of 1.01 (1.01 – 1.02). The study has demonstrated an increased risk of adverse perinatal outcomes including preterm labour, IUGR, LBW and neonatal asphyxia in women experiencing threatened miscarriage in the early pregnancy. Conclusions: A prediction model was developed to predict miscarriage in threatened miscarriage population using makers including age, hCG, inhibin and FHR. Future studies focussing on developing markers of adverse perinatal outcomes in women experiencing bleeding in early pregnancy will help to plan the antenatal care of high-risk women with bleeding in early pregnancy.