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Yolk sac diameter and shape - predictors of outcome in the first trimester of pregnancy complicated with type-1 diabetes mellitus

Information on the predictive value in normal and pregnancy complicated with type-1 diabetes mellitus outcome, of yolk sac (YS) measurement and YS morphology has been scanned. During first trimester, peripherally placed (within gestational sac) YS measuring 5 mm or less is likely to be normal. YS maybe smaller or larger of 5 mm in abnormal pregnancies, than in intact pregnancies of equal size. Aim: To compare the size and shape at transvaginal sonography (TVS) of YS in normal and type 1 diabetic pregnancies and to correlate these characteristics with perinatal outcome. Patient and methods: 60 healthy pregnancies and 60 pregnancies with type 1 DM underwent TVS in the first trimester to establish the normal size and shape: TVS was performed at least 2 times between 6-12 weeks of menstrual age (MA), and HCG was measured at he same day of TVS as well. We calculated the correlation coefficient between YS and MA, YS and crown-rump length, YS and gestational sac diameter, and YS and HCG. Student-t test and Mann-Whitney test were used for statistical analysis with SPSS 10 software. Results: The high statistical positive correlation was found between YS diameter and MA, crown-rump length and diameter of YS for both studied groups. The YS diameter in type-1 DM pregnancies was statistically significantly larger for MA, than that of healthy pregnant women. YS in type-1 DM showed slower regression after 10 weeks of MA than in healthy pregnancies. The unfavorable perinatal outcome in healthy pregnant women was connected with YS measuring 5 mm and less with hypoechogenic sonographic characteristics. YS measuring more than 6 mm were found in 30/60 of type-1 DM group. Perinatal outcome was favorable in 20/30 cytogenetic malformation occurred in type-1 DM group. It is unknown if abnormalities of YS are related primarily to YS or secondarily to embryonic maldevelopment. Gross change in its size and/or shape may indicate or reflect significant dysfunction of the maternal-fetal transport system in early pregnancy. The larger size of YS could be of maternal hyperglycemia and accumulation of nutritive secretions not used by embryo, resulting more frequently in diabetic embryopathy.

yolk sac; DM type 1; pregnancy

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