As many as 25 percent of women who ...

As many as 25 percent of women who are pregnant experience vaginal bleeding during the first trimester. Approximately single half of these women progres to miscarriage. Early identification of the nonviable pregnancies in consequence of ultrasonography provides more time for decisions about expectant management or intervention. reciprocally confirming viability can offer patients reassurance. Schauberger and colleagues studied the contribution of ultrasonography to the management of first-trimester bleeding.

The researchers studied all pregnant women admitted to a regional medical center between 1998 and 2000 with first-trimester bleeding. Of the 715 women who underwent ultrasound examination, 314 were assessed as having viable pregnancies, 236 had nonviable pregnancies, and 39 had ectopic pregnancies. No pregnancy was identified in the remaining 126 women In the clump deemed viable by ultrasonography, pregnancy continued to the cessation of the first trimester in 270 women (86 percent) Spontaneous abortion occurr in 16 patients (5 percent) and five (2 percent) required juncture evacuation because of severe bleeding. The remaining 23 patients (7 percent) underwent scheduled evacuation. In the 236 women with nonviable pregnancies in succession ultrasound, 96 (41 percent) opt for expectant management. Spontaneous abortion occurr within a week in 70 percent of these patients. The final diagnoses for the clump with no intrauterine pregnancy were: (1) clean spontaneous abortion (80 percent); (2) ectopic pregnancy (17 percent); and (3) viable pregnancies (2 percent) In the entire dispose of 715 women studied, the sole complication was one mild case of postabortion endometritis.

If ultrasonography reported a nonviable pregnancy, expectant management was significantly les expensive than scheduled curettage ($652 compared with $1966) Spontaneous abortion ($878) also was significantly les expensive than scheduled or pass evacuation ($2,473 and $6,208, respectively) for women who eventually miscarried after initial ultrasonography revealed a viable pregnancy.

The authors end that ultrasonographic demonstration of fetal heartbeat is highly predictive of viability in the first trimester, flat if vaginal bleeding occurs, because approximately 86 percent of these pregnancies continue. They emphasize that expectant management was fortunate in 74 percent of nonviable pregnancies and that 70 percent resolv in miscarriage within united week. Overall, ultrasonography provided physicians and patients with crucial information to use in management decisions.

ANNE D WALLING, MD Schauberger CW Mathiason MA, Rooney BL Ultrasound assessment of first-trimester bleeding. Obstet Gynecol Februrary 2005;105:333-8

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