{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:20:20Z","timestamp":1784557220297,"version":"3.55.0"},"reference-count":25,"publisher":"Bioscientifica","issue":"4","license":[{"start":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T00:00:00Z","timestamp":1696118400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["raf.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,11,10]]},"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>\n                      Embryo implantation is vital for successful conception but remains to be fully understood. Trophoblast invasion is key for implantation, with anchorage and depth of placentation determined by its extent. There is a dearth of synchronous information regarding IVF, implantation site, and trophoblastic thickness (TT). Our aim was to determine whether pregnancy implantation site and TT, had an impact on outcomes of IVF pregnancies. This prospective observational study was undertaken at a tertiary referral UK fertility unit over 14 months, collecting data on implantation site and TT from three-dimensional (3D) images of the uterus following early pregnancy scan. Of the 300 women recruited, 277 (92%) had live births, 20 (7%) miscarried, 2 (0.7%) had stillbirths, and 1 (0.3%) had a termination. Significantly more pregnancies that resulted in miscarriage (7\/20, 35%) were located in the lower uterine cavity when compared to ongoing pregnancies (15\/277, 5%) (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.01). TT was significantly higher in ongoing pregnancies when compared with those who miscarried (7.2 mm vs 5.5 mm;\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.01). Implantation in the lower half of the uterine cavity and decreased TT are significantly associated with an increased rate of miscarriage. Identification of those at risk should prompt increased monitoring with the aim of supporting these pregnancies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Lay summary<\/jats:title>\n                    <jats:p>Implantation of an embryo in the womb is vital for a successful pregnancy. We wanted to find out whether findings on an ultrasound scan in early pregnancy had an impact on outcomes of IVF pregnancies. Three hundred women were recruited to the study, 277 (92%) had live births and unfortunately 20 (7%) had a miscarriage, 2 (0.7%) had stillbirths, and 1 (0.3%) had a termination. Many more of the pregnancies that miscarried implanted in the lower part of the womb. The thickness of the infiltration of the pregnancy into the womb was significantly higher in the ongoing pregnancies. We concluded that implantation in the lower half of the womb and reduced infiltration of the pregnancy seen on scan are associated with an increased rate of miscarriage. We propose that when we identify those at risk, we should increase monitoring, with the aim of supporting these pregnancies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/raf-23-0044","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T10:17:09Z","timestamp":1699611429000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-13","source":"Crossref","is-referenced-by-count":0,"title":["Implantation in the lower half of the uterine cavity and decreased trophoblastic thickness can predict subsequent miscarriage: a prospective cohort study"],"prefix":"10.1530","volume":"4","author":[{"given":"Lewis","family":"Nancarrow","sequence":"first","affiliation":[{"name":"Centre for Women's Health Research, Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK"},{"name":"Hewitt Centre for Reproductive Medicine, Liverpool Women\u2019s NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3633-1592","authenticated-orcid":true,"given":"Nicola","family":"Tempest","sequence":"additional","affiliation":[{"name":"Centre for Women's Health Research, Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK"},{"name":"Hewitt Centre for Reproductive Medicine, Liverpool Women\u2019s NHS Foundation Trust, Liverpool, UK"},{"name":"Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suganthi","family":"Vinayagam","sequence":"additional","affiliation":[{"name":"Hewitt Centre for Reproductive Medicine, Liverpool Women\u2019s NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Lane","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, University of Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J","family":"Drakeley","sequence":"additional","affiliation":[{"name":"Hewitt Centre for Reproductive Medicine, Liverpool Women\u2019s NHS Foundation Trust, Liverpool, UK"},{"name":"Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Homburg","sequence":"additional","affiliation":[{"name":"Hewitt Centre for Reproductive Medicine, Liverpool Women\u2019s NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Russell","sequence":"additional","affiliation":[{"name":"Hewitt Centre for Reproductive Medicine, Liverpool Women\u2019s NHS Foundation Trust, Liverpool, UK"},{"name":"Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0270-0150","authenticated-orcid":true,"given":"Dharani K","family":"Hapangama","sequence":"additional","affiliation":[{"name":"Centre for Women's Health Research, Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Member of Liverpool Health Partners, Liverpool, UK"},{"name":"Liverpool Women's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Reproductive Biology and Endocrinology","first-page":"21","article-title":"Endometrial response to IVF hormonal manipulation: comparative analysis of menopausal, down regulated and natural cycles","volume":"2","author":"Adams","year":"2004","unstructured":"Adams SMTerry VHosie MJGayer N & Murphy CR2004Endometrial response to IVF hormonal manipulation: comparative analysis of menopausal, down regulated and natural cycles. Reproductive Biology and Endocrinology221. (https:\/\/doi.org\/10.1186\/1477-7827-2-21)"},{"key":"bib2","series-title":"Human Fertility","first-page":"169","article-title":"Trophoblast invasion","volume":"7","author":"Anin","year":"2004","unstructured":"Anin SAVince G & Quenby S2004Trophoblast invasion. Human Fertility7169\u2013174. (https:\/\/doi.org\/10.1080\/14647270400006911)"},{"key":"bib3","series-title":"Ultrasound in Obstetrics and Gynecology","first-page":"194","article-title":"Clinical implications of machine-probe combinations on obstetric ultrasound measurements used in pregnancy dating","volume":"40","author":"Axell","year":"2012","unstructured":"Axell RLynch CChudleigh TBradshaw LMangat JWhite P & Lees C2012Clinical implications of machine-probe combinations on obstetric ultrasound measurements used in pregnancy dating. Ultrasound in Obstetrics and Gynecology40194\u2013199. (https:\/\/doi.org\/10.1002\/uog.11081)"},{"key":"bib4","series-title":"Human Reproduction","first-page":"1629","article-title":"Is trophoblastic thickness at the embryonic implantation site a new sign of negative evolution in first trimester pregnancy?","volume":"15","author":"Bajo","year":"2000","unstructured":"Bajo JMoreno-Calvo FJMartinez-Cort\u00e9s LHaya FJ & Rayward J2000Is trophoblastic thickness at the embryonic implantation site a new sign of negative evolution in first trimester pregnancy?Human Reproduction151629\u20131631. (https:\/\/doi.org\/10.1093\/humrep\/15.7.1629)"},{"key":"bib5","series-title":"Reproductive Biology and Endocrinology","first-page":"121","article-title":"Recurrent Implantation Failure-update overview on etiology, diagnosis, treatment and future directions","volume":"16","author":"Bashiri","year":"2018","unstructured":"Bashiri AHalper KI & Orvieto R2018Recurrent Implantation Failure-update overview on etiology, diagnosis, treatment and future directions. Reproductive Biology and Endocrinology16121. (https:\/\/doi.org\/10.1186\/s12958-018-0414-2)"},{"key":"bib6","series-title":"Human Reproduction Update","first-page":"242","article-title":"Implantation failure: molecular mechanisms and clinical treatment","volume":"17","author":"Cakmak","year":"2011","unstructured":"Cakmak H & Taylor HS2011Implantation failure: molecular mechanisms and clinical treatment. Human Reproduction Update17242\u2013253. (https:\/\/doi.org\/10.1093\/humupd\/dmq037)"},{"key":"bib7","series-title":"Reproductive Biomedicine Online","first-page":"541","article-title":"Implantation sites after embryo transfer into the central area of the uterine cavity","volume":"13","author":"Cavagna","year":"2006","unstructured":"Cavagna MContart PPetersen CGMauri ALMartins AMBaruffi RLOliveira JB & Franco JG2006Implantation sites after embryo transfer into the central area of the uterine cavity. Reproductive Biomedicine Online13541\u2013546. (https:\/\/doi.org\/10.1016\/s1472-6483(1060642-6)"},{"key":"bib8","series-title":"Nature Reviews","first-page":"466","article-title":"Pre-eclampsia part 1: current understanding of its pathophysiology","volume":"10","author":"Chaiworapongsa","year":"2014","unstructured":"Chaiworapongsa TChaemsaithong PYeo L & Romero R2014Pre-eclampsia part 1: current understanding of its pathophysiology. Nature Reviews10466\u2013480. (https:\/\/doi.org\/10.1038\/nrneph.2014.102)"},{"key":"bib9","series-title":"Women\u2019s Health","first-page":"501","article-title":"3D ultrasound in gynecology and reproductive medicine","volume":"4","author":"Coyne","year":"2008","unstructured":"Coyne LJayaprakasan K & Raine-Fenning N20083D ultrasound in gynecology and reproductive medicine. Women\u2019s Health4501\u2013516. (https:\/\/doi.org\/10.2217\/17455057.4.5.501)"},{"key":"bib10","series-title":"Stem Cell Reviews and Reports","first-page":"764","article-title":"Side-population trophoblasts exhibit the differentiation potential of a trophoblast stem cell population, persist to term, and are reduced in fetal growth restriction","volume":"16","author":"Gamage","year":"2020","unstructured":"Gamage TKPerry JJFan VGroom KChamley LW & James JL2020Side-population trophoblasts exhibit the differentiation potential of a trophoblast stem cell population, persist to term, and are reduced in fetal growth restriction. Stem Cell Reviews and Reports16764\u2013775. (https:\/\/doi.org\/10.1007\/s12015-020-09991-8)"},{"key":"bib11","series-title":"Ultrasound in Obstetrics and Gynecology","first-page":"629","article-title":"Ultrasound features prior to 11 weeks' gestation and first-trimester maternal factors in prediction of hypertensive disorders of pregnancy","volume":"55","author":"Hanchard","year":"2020","unstructured":"Hanchard TJde Vries BSQuinton AESinosich M & Hyett JA2020Ultrasound features prior to 11 weeks' gestation and first-trimester maternal factors in prediction of hypertensive disorders of pregnancy. Ultrasound in Obstetrics and Gynecology55629\u2013636. (https:\/\/doi.org\/10.1002\/uog.21962)"},{"key":"bib12","series-title":"Acta Obstetricia et Gynecologica Scandinavica","first-page":"983","article-title":"Development of placental abnormalities in location and anatomy","volume":"99","author":"Jansen","year":"2020","unstructured":"Jansen CHJRKastelein AWKleinrouweler CEVan Leeuwen EDe Jong KHPajkrt E & Van Noorden CJF2020Development of placental abnormalities in location and anatomy. Acta Obstetricia et Gynecologica Scandinavica99983\u2013993. (https:\/\/doi.org\/10.1111\/aogs.13834)"},{"key":"bib13","series-title":"Ultrasound in Obstetrics and Gynecology","first-page":"727","article-title":"Prevalence of uterine anomalies and their impact on early pregnancy in women conceiving after assisted reproduction treatment","volume":"37","author":"Jayaprakasan","year":"2011","unstructured":"Jayaprakasan KChan YYSur SDeb SClewes JS & Raine-Fenning NJ2011Prevalence of uterine anomalies and their impact on early pregnancy in women conceiving after assisted reproduction treatment. Ultrasound in Obstetrics and Gynecology37727\u2013732. (https:\/\/doi.org\/10.1002\/uog.8968)"},{"key":"bib14","series-title":"Fertility and Sterility","first-page":"1168","article-title":"Measurement of endometrial tissue blood flow: a novel way to assess uterine receptivity for implantation","volume":"76","author":"Jinno","year":"2001","unstructured":"Jinno MOzaki TIwashita MNakamura YKudo A & Hirano H2001Measurement of endometrial tissue blood flow: a novel way to assess uterine receptivity for implantation. Fertility and Sterility761168\u20131174. (https:\/\/doi.org\/10.1016\/s0015-0282(0102897-7)"},{"key":"bib15","series-title":"Development and Reproduction","first-page":"351","article-title":"A review of mechanisms of implantation","volume":"21","author":"Kim","year":"2017","unstructured":"Kim SM & Kim JS2017A review of mechanisms of implantation. Development and Reproduction21351\u2013359. (https:\/\/doi.org\/10.12717\/DR.2017.21.4.351)"},{"key":"bib16","series-title":"Nihon Sanka Fujinka Gakkai Zasshi","first-page":"102","article-title":"Clinical significance of detection time and site of early gestational sac by ultrasonography","volume":"46","author":"Kinoshita","year":"1994","unstructured":"Kinoshita K1994Clinical significance of detection time and site of early gestational sac by ultrasonography. Nihon Sanka Fujinka Gakkai Zasshi46102\u2013108. Available at: https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/8126381"},{"key":"bib17","series-title":"PLoS Medicine","first-page":"e1002220","article-title":"The World Health Organization fetal growth charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight","volume":"14","author":"Kiserud","year":"2017","unstructured":"Kiserud TPiaggio GCarroli GWidmer MCarvalho JNeerup Jensen LGiordano DCecatti JGAbdel Aleem HTalegawkar SA, 2017The World Health Organization fetal growth charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Medicine14e1002220. (https:\/\/doi.org\/10.1371\/journal.pmed.1002220)"},{"key":"bib18","series-title":"Journal of Nippon Medical School","first-page":"250","article-title":"Determination of blastocyst implantation site in spontaneous pregnancies using three-dimensional transvaginal ultrasound","volume":"70","author":"Minami","year":"2003","unstructured":"Minami SIshihara K & Araki T2003Determination of blastocyst implantation site in spontaneous pregnancies using three-dimensional transvaginal ultrasound. Journal of Nippon Medical School70250\u2013254. (https:\/\/doi.org\/10.1272\/jnms.70.250)"},{"key":"bib19","series-title":"Medicina","article-title":"Fetal growth acceleration-current approach to the big baby issue","volume":"57","author":"Modzelewski","year":"2021","unstructured":"Modzelewski JKajdy AMuzyka-Placzynska KSys D & Rabijewski M2021Fetal growth acceleration-current approach to the big baby issue. Medicina57. (https:\/\/doi.org\/10.3390\/medicina57030228)"},{"key":"bib20","series-title":"International Journal of Molecular Sciences","first-page":"1973","article-title":"Physiologic events of embryo implantation and decidualization in human and non-human Primates","volume":"21","author":"Ochoa-Bernal","year":"2020","unstructured":"Ochoa-Bernal MA & Fazleabas AT2020Physiologic events of embryo implantation and decidualization in human and non-human Primates. International Journal of Molecular Sciences211973. (https:\/\/doi.org\/10.3390\/ijms21061973)"},{"key":"bib21","series-title":"Journal of Clinical Ultrasound","first-page":"316","article-title":"Intra- and interobserver variability of 2D and 3D transvaginal sonography in the diagnosis of benign versus malignant adnexal masses","volume":"39","author":"Pascual","year":"2011","unstructured":"Pascual MAGraupera BHereter LRotili ARodriguez I & Alcazar JL2011Intra- and interobserver variability of 2D and 3D transvaginal sonography in the diagnosis of benign versus malignant adnexal masses. Journal of Clinical Ultrasound39316\u2013321. (https:\/\/doi.org\/10.1002\/jcu.20808)"},{"key":"bib22","series-title":"Journal of Physiology","first-page":"3453","article-title":"Intrauterine growth restriction, human placental development and trophoblast cell death","volume":"587","author":"Scifres","year":"2009","unstructured":"Scifres CM & Nelson DM2009Intrauterine growth restriction, human placental development and trophoblast cell death. Journal of Physiology5873453\u20133458. (https:\/\/doi.org\/10.1113\/jphysiol.2009.173252)"},{"key":"bib23","series-title":"Journal of Assisted Reproduction and Genetics","first-page":"1227","article-title":"Assessment and treatment of repeated implantation failure (RIF)","volume":"29","author":"Simon","year":"2012","unstructured":"Simon A & Laufer N2012Assessment and treatment of repeated implantation failure (RIF). Journal of Assisted Reproduction and Genetics291227\u20131239. (https:\/\/doi.org\/10.1007\/s10815-012-9861-4)"},{"key":"bib24","series-title":"Lancet","first-page":"2089","article-title":"Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study","volume":"386","author":"Sovio","year":"2015","unstructured":"Sovio UWhite IRDacey APasupathy D & Smith GCS2015Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study. Lancet3862089\u20132097. (https:\/\/doi.org\/10.1016\/S0140-6736(1500131-2)"},{"key":"bib25","series-title":"Australian and New Zealand Journal of Obstetrics and Gynaecology","first-page":"641","article-title":"First-trimester ultrasound features associated with subsequent miscarriage: a prospective study","volume":"59","author":"Taylor","year":"2019","unstructured":"Taylor TJQuinton AEde Vries BS & Hyett JA2019First-trimester ultrasound features associated with subsequent miscarriage: a prospective study. Australian and New Zealand Journal of Obstetrics and Gynaecology59641\u2013648. 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