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目的:探讨妊娠囊相对大小及联合孕酮水平预测早孕妊娠结局的临床价值。方法:回顾性队列研究选取2020年4月至2023年6月期间在上海市长宁区妇幼保健院超声医学科接受早孕超声检查的患者，使用经阴道二维超声测量妊娠囊三径（纵径、横径、前后径）和胚芽长度，并记录3 d内孕酮水平，随访至妊娠满12周。分别根据妊娠囊径线（Hellman公式）和胚芽长度（Hadlock公式）计算孕周，按照孕周相对大小把患者分成妊娠囊偏小组（ n=100）和妊娠囊正常组（ n=500）；比较两组妊娠囊相对大小和孕酮的差异，对于有统计学意义的指标通过受试者工作特征曲线计算其预测早孕妊娠结局的效能。 结果:①妊娠囊正常组的妊娠囊相对大小（3.24±1.06）与妊娠囊偏小组（1.65±0.56）比较，差异具有统计学意义（ P=0.004）。超声测量妊娠囊相对大小预测早孕妊娠结局不良的阳性预测值为97.00%（97/100），阴性预测值为94.20%（471/500），灵敏度为76.98%（97/126），特异度为99.37%（471/474），总体准确率为94.67%（568/600）。②妊娠囊正常组孕酮水平为（68.4±37.2）nmol/L，妊娠囊偏小组孕酮水平为（29.6±11.8）nmol/L，两组比较差异有统计学意义（ P<0.001）。③受试者工作特征曲线显示妊娠囊相对大小、孕酮水平、妊娠囊相对大小联合孕酮水平预测早期妊娠结局的曲线下面积分别为0.804、0.818、0.847，妊娠囊相对大小的预测临界值为2.40，孕酮的预测临界值为37.6 nmol/L。④超声参数妊娠囊相对大小单独预测早期妊娠结局不良的灵敏度为76.98%（97/126）。孕酮水平单独预测早期妊娠结局不良的灵敏度为78.57%（99/126）。以妊娠囊相对大小与孕酮水平联合预测早期妊娠结局不良，则灵敏度提升为84.92%（107/126）。 结论:超声测量和计算妊娠囊相对大小简单易行，超声参数妊娠囊相对大小对于早孕妊娠结局具有较好的预测价值；妊娠囊相对大小联合血清孕酮水平的预测效能更佳。

Objective:To explore the clinical value of the relative size of gestational sac and serum progesterone levels in predicting early pregnancy outcomes.Methods:Retrospective cohort study selected patients who underwent early pregnancy ultrasound examination at the Ultrasound Medicine Department of Shanghai Changning Maternity and Infant Health Hospital from April 2020 to June 2023. Transvaginal two-dimensional ultrasound was used to measure the three diameters of the gestational sac (longitudinal diameter, transverse diameter, anterior-posterior diameter) and fetal pole length. Serum progesterone levels were tested in 3 d. All patients were followed up until 12 weeks of gestation to estimate the early pregnancy outcomes. Gestational age was calculated based on the gestational sac diameter line (Hellman's formula) and embryo length (Hadlock's formula), and the patients were divided into the gestational sac deviation group (deviation group, n=100) and the gestational sac normal group (normal group, n=500) based on the relative size of gestational age. The relative size of the gestational sac and progesterone level were compared between the two groups, and the effectiveness of predicting early pregnancy outcomes for statistically significant indicators was calculated with receiver operating characteristic curve. Results:1) The relative size of gestational sac in the normal group and the deviation group were 3.24±1.06 and 1.65±0.56, respectively, and the difference between the two groups was statistically significant ( P=0.004). The positive predictive value of ultrasound gestational sac size for predicting adverse pregnancy outcome in the first trimester was 97.00% (97/100) and the negative predictive value was 94.2% (471/500). 2) The levels of progesterone in the normal group and the deviation group were (68.4±37.2) nmol/L and (29.6±11.8) nmol/L, respectively, with a statistically significant difference ( P<0.001). 3) The areas under receiver operating characteristic curves of the relative size of gestational sac, progesterone levels and the both combined in predicting early pregnancy outcomes were 0.804, 0.818 and 0.847, respectively, and the cut-off values of the relative size of pregnancy sac and progesterone was 2.40 and 37.6 nmol/L, respectively. 4) The accuracy of the relative size of gestational sac in predicting adverse outcomes in early pregnancies was 76.98% (97/126). The accuracy of progesterone in predicting adverse outcomes in early pregnancy was 78.57% (99/126). When the both combined, the predicting accuracy was increased to 84.92% (107/126). Conclusion:It is easy to measure and calculate the relative size of pregnancy sac by ultrasound, which provided a good predictive value for the outcomes of early pregnancies. The relative size of pregnancy sac combined with progesterone levels showed better predictive efficacy.