Intrauterine Pregnancy of Uncertain Viability (IPUV): Management and Outcomes.
Dr Jessica Teoh, Ms Hayley Diplock, Ms Melissa Wang, Ms Sarah Mead, A/Prof Bradley De Vries, Dr Joanne Ludlow
Women and Babies Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
Background:
•IPUV is seen in 10-29% of all intra-uterine pregnancies
oFetal pole of < 7mm with no fetal heartbeat
oMGSD <25 mm with no visible fetal pole or yolk sac
•Two groups of IPUV
i.Having a scan too early
ii.Poor prognostic signs – eg discrepancy between the menstrual/IVF and ultrasound dates
•Inconsistent timeframe for determining pregnancy viability
•Emotional distress well demonstrated
•Possibly other adverse outcomes?
Aim:
1.Outcomes for women initially diagnosed with an IPUV and whether there are differences between IVF and spontaneously conceived pregnancies.
2.Whether women who subsequently miscarried after IPUV compared with those who had an initial diagnosis of missed miscarriage (MMC)were more likely to present to Emergency, have haemodynamic instability and/or require emergency dilatation and curettage (D&C).
3. Compliance with the guidelines for repeat scans
Study Design and Methods:
•Retrospective cohort study at tertiary hospital early pregnancy assessment clinic (01/01/2019 to 31/12/2021).
•All women with an IPUV on initial ultrasound were included. Outcome measures were time interval between scans, number of scans required for definitive diagnosis, viability at 11-14 weeks gestation, and management of a subsequent miscarriage. Comparisons were made between IVF and spontaneous pregnancies. The number of ED presentations, estimated blood loss (EBL) at D&C, haemodynamic instability, and need for blood transfusion were compared between those diagnosed at initial scan with IPUV and those with MMC who elected to have surgical management
Results:
12% of women with IUPV were scanned earlier than recommended.
•1065 pregnancies (771 IPUV, 294 MMC electing D&C) were included. Mean age 34 years. 90% spontaneous and 10% IVF pregnancies.
•12% had repeat scans less than seven days apart.
•29% IPUVs were subsequently viable at 11-14 weeks. 7% in IVF and 32% naturally conceived pregnancies (p<0.001).
•IVF pregnancies had a shorter interval to definitive diagnosis (11.5 days vs 16.5 days, p<0.001), lower rates of spontaneous miscarriage (19% vs 33%, p=0.001), and fewer ED presentations (14% vs 25%, p=0.03), and lower EBL at D&C (50ml vs 95ml, p=0.001)
•IPUV subsequently diagnosed with a miscarriage had more ED presentations (33% vs 7%, p<0.001) and more emergency D&Cs (11% vs 7%, p=0.01) compared with a MMC.
Conclusion:
•Women with IPUV compared with initial MMC had
•A higher incidence of ED presentations for vaginal bleeding and abdominal pain
•An increased need for an emergency D&C
•IPUV in IVF pregnancies
•6% are viable at 11-14 weeks gestation
•Could the criteria be less conservative for IVF pregnancies?
