https://www.um.edu.mt/library/oar/handle/123456789/324 2026-04-04T21:53:04Z https://www.um.edu.mt/library/oar/handle/123456789/145226 Title: Beyond the bleeding : predicting pregnancy outcomes after threatened miscarriage Abstract: This three-phase research project examined pregnancy outcomes following first-trimester threatened miscarriage (TM). Phase 1 (retrospective epidemiological analysis) established local prevalence and outcome patterns in Malta for 2019. Phase 2 (scoping review) mapped existing ultrasound and biochemical markers for predicting miscarriage. Phase 3 (prospective case-control study) developed and validated predictive models using multivariate logistic regression (AUC 0.89 on test data) and Random Forest (AUC 0.97 on test data). Key predictive markers identified were progesterone, mean gestational sac diameter (MGSD), β-hCG, crown-rump length (CRL), cervical length, maternal age (35–46 years), fetal heart rate (FHR), and sFlt-1:PlGF ratio. The study provides the first Malta-specific data and a clinically usable algorithm to improve risk stratification and counselling for women experiencing early-pregnancy bleeding. 2025-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145225 Title: Improving early pregnancy outcomes : predictive tools for threatened miscarriage Abstract: This presentation is aimed to develop predictive tools for pregnancy outcomes in cases of threatened miscarriage through a three-phase approach. The retrospective phase analysed local Maltese data on first-trimester bleeding. The scoping review evaluated existing ultrasonographic and biochemical markers. The prospective case-control study developed and validated a Random Forest model that incorporates progesterone, MGSD, β-hCG, CRL, cervical length, maternal age, FHR, and the sFlt-1:PlGF ratio. The model achieved 93% accuracy and an AUC of 0.96, and provides a solid foundation for the development of clinical decision-support tools. 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145224 Title: Understanding the prevalence of threatened miscarriage in Malta Abstract: Threatened miscarriage (TM) is vaginal bleeding before 20 weeks of pregnancy with a detectable fetal heartbeat and closed cervical os. This retrospective cohort study quantified the prevalence of TM and pregnancy outcomes in Malta. All 711 women presenting with first-trimester vaginal bleeding at Mater Dei Hospital’s Accident & Emergency department in 2019 were analysed. Outcomes were: 241 (33.9 %) live births beyond 22 weeks’ gestation, 396 (55.7 %) confirmed miscarriages, 10 (1.4 %) ectopic pregnancies, 6 (0.84 %) molar pregnancies, and 58 (8.16 %) unknown. Successful birth rates were significantly lower in mothers aged 35–46 years, and neonates showed a tendency toward low birth weight. The study provides the first national prevalence data for TM in Malta and forms the basis for a future prospective study on pregnancy outcomes following TM. 2024-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145223 Title: Assessing the predictive value of first trimester ultrasound and biochemical markers in miscarriage Abstract: Vaginal bleeding in the first trimester causes significant anxiety for expectant parents. Although ultrasound plays a central role in early pregnancy assessment, predicting miscarriage remains challenging. This scoping review examined the predictive value of first-trimester ultrasound (US) markers used alone, in combination, or alongside biochemical (BC) markers. A systematic search of four databases (20 January 2022 and 23 March 2023) using MeSH terms identified 3,608 studies. After screening, 128 studies were included (82 single-US-marker studies and 46 multiple-marker studies). The most frequently investigated US markers were intrauterine haematoma, yolk sac, and fetal heart rate; progesterone was the commonest BC marker. While several markers showed promising predictive value, methodological variations across studies mean no standardised predictive model currently exists for clinical use. 2023-01-01T00:00:00Z