title: Fetal loss in symptomatic first-trimester pregnancy with documented yolk sac intrauterine pregnancy.
abstract: BACKGROUND
  The possibility of spontaneous miscarriage is a common concern among pregnant women in the emergency department (ED).
  
  
  OBJECTIVE
  This study sought to determine fetal outcomes for women following ED evaluation for first-trimester abdominopelvic pain or vaginal bleeding who had an intrauterine pregnancy (IUP) on ultrasound before a visible fetal pole ("yolk sac IUP").
  
  
  METHODS
  A retrospective chart review of consecutive ED charts from December 2005 to September 2006 identified patients with a yolk sac IUP. Demographic data, obstetric/gynecologic history, and presenting symptoms were obtained. Outcomes were determined via computerized records. Fetal loss was diagnosed by falling β-human chorionic gonadotropin or pathology specimen. Live birth was diagnosed by viable fetus at 20-week ultrasound or delivery.
  
  
  RESULTS
  A total of 131 patients were enrolled in this study. Of these, 14 were lost to follow-up (12%), leaving 117 patient encounters. Of the 117 women, 82 carried their pregnancies to at least 20-week gestation. Thirty-five patients miscarried. Fetal loss rate by chief complaint were as follows: 8 of 46 patients presenting with pain only, 14 of 34 presenting with vaginal bleeding only, and 13 of 37 with both vaginal bleeding and pain.
  
  
  CONCLUSIONS
  Seventy percent of women diagnosed with a yolk sac IUP in the ED carried their pregnancy to at least 20 weeks. The remaining women (30%) experienced fetal loss. Vaginal bleeding (with or without pain) increased the rate of fetal loss compared with women with pain only. These data will assist the emergency physician in counseling women with symptomatic first-trimester pregnancies.
authors.affiliation: Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA USA. maryjo.hessert@med.navy.mil
authors.forename: Mary Josephine
authors.initials: MJ
authors.lastname: Hessert
authors.forename: Michael
authors.initials: M
authors.lastname: Juliano
mesh_terms: D015746:Abdominal Pain; D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D058746:Gestational Sac / Q000000981:diagnostic imaging; D006801:Humans; D008137:Longitudinal Studies; D010146:Pain; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011258:Pregnancy Tests; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies; D012306:Risk; D016216:Ultrasonography, Prenatal; D014592:Uterine Hemorrhage; D015017:Yolk Sac / Q000000981:diagnostic imaging; D055815:Young Adult