RT Journal Article
SR Electronic
T1 Fetal outcomes following emergency department point-of-care ultrasound for vaginal bleeding in early pregnancy
JF Canadian Family Physician
JO Can Fam Physician
FD The College of Family Physicians of Canada
SP 572
OP 578
VO 62
IS 7
A1 Catherine Varner
A1 Dahlia Balaban
A1 Bjug Borgundvaag
A1 Shelley McLeod
A1 Sally Carver
YR 2016
UL http://www.cfp.ca/content/62/7/572.abstract
AB Objective To determine 20- and 40-week fetal outcomes following documentation of fetal cardiac activity (FCA) and intrauterine pregnancy (IUP) in women at less than 20 weeks’ gestation presenting to the emergency department (ED) with vaginal bleeding.Design Prospective observational cohort study.Setting Single-centre tertiary care ED.Participants Pregnant women at less than 20 weeks’ gestation presenting to the ED with vaginal bleeding.Intervention All study participants underwent ED point-of-care ultrasound (POCUS) to document IUP and FCA.Main outcome measures Prevalence of spontaneous abortion or pregnancy loss by 40 weeks’ gestational age following ED POCUS documentation of FCA or IUP in women at less than 20 weeks’ gestation.Results A total of 85 of 111 eligible patients were enrolled; FCA and IUP were detected in 43 (50.6%) and 54 (63.5%) participants, respectively. Participants with documented FCA on ED POCUS were less likely to experience pregnancy loss than participants without documented FCA were (5.0% vs 92.7%; Δ = 87.7%; 95% CI 71.0% to 93.7%), and participants with documented IUP were less likely to experience pregnancy loss than participants without documented IUP were (22.0% vs 93.5%; Δ = 71.5%; 95% CI 52.1% to 81.9%). Compared with radiologist-interpreted ultrasound, ED POCUS had sensitivity of 88.9% (95% CI 75.9% to 96.2%) and specificity of 100.0% (95% CI 89.6% to 100.0%) for documenting FCA, and sensitivity of 96.0% (95% CI 86.3% to 99.4%) and specificity of 93.1% (95% CI 77.2% to 99.0%) for documenting IUP.Conclusion In this cohort of women presenting to the ED with bleeding in the first 20 weeks of pregnancy, detection of IUP and especially FCA using POCUS performed by providers certified by the Canadian Emergency Ultrasound Society was associated with ongoing viable pregnancy at 20 and 40 weeks’ gestational age. These data might be useful for ED physicians counseling women with symptomatic early pregnancies about the chance of miscarriage after an episode of vaginal bleeding.