Characteristics of women with fetal loss in symptomatic first trimester pregnancies with documented fetal cardiac activity

Michael Juliano, Stephanie Dabulis, Alan Heffner
Annals of Emergency Medicine 2008, 52 (2): 143-7

STUDY OBJECTIVE: The purpose of this study is to determine fetal outcomes of women diagnosed with live intrauterine pregnancy after emergency department (ED) presentation for abdominopelvic pain or vaginal bleeding during the first trimester.

METHODS: A retrospective medical record review of prospectively recorded data of consecutive ED charts from December 2005 to June 2006 was performed to identify patients diagnosed with live intrauterine pregnancy. Demographic data, obstetric/gynecologic history, and presenting symptoms were obtained. Outcomes were determined by computerized medical records. Fetal loss was diagnosed by decreasing beta-Human chorionic gonadotropin or pathology specimen. Live birth was diagnosed by viable fetus at 20-week-gestation ultrasonography or delivery.

RESULTS: A total of 837 patients were evaluated during the first trimester. Three hundred forty patients (41%) met inclusion criteria, with a diagnosis of live intrauterine pregnancy. Outcome data were obtained for 303 (89%) of these patients. Fetal loss occurred in 28 (9.2%) pregnancies (95% confidence interval [CI] 5.9% to 12.5%). Fetal loss incidence was 13.8% (95% CI 9.9% to 17.7%) in patients presenting with vaginal bleeding compared with 2.5% (95% CI 0.007% to 4.3%) in patients without bleeding (P<0.002). Twenty five of 28 (89%) patients with resulting fetal loss presented with vaginal bleeding. Vaginal bleeding was the most important predictor of fetal loss; risk ratio 5.6 (95% CI 1.7 to 18.2).

CONCLUSION: Fetal loss before 20 weeks occurs in 9.2% of patients with live intrauterine pregnancy diagnosed by ultrasonography. Vaginal bleeding carries a higher fetal loss rate of 13.8%. These data will assist the emergency physician in counseling women experiencing symptomatic first trimester pregnancy.

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