Fetal outcomes following emergency department point-of-care ultrasound for vaginal bleeding in early pregnancy.
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.


METHODS
Prospective observational cohort study.


METHODS
Single-centre tertiary care ED.


METHODS
Pregnant women at less than 20 weeks' gestation presenting to the ED with vaginal bleeding.


METHODS
All study participants underwent ED point-of-care ultrasound (POCUS) to document IUP and FCA.


METHODS
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.


CONCLUSIONS
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.
Clinician-scientist in the Schwartz/Reisman Emergency Medicine Institute and an emergency physician at Mount Sinai Hospital in Toronto, Ont.
Catherine
C
Varner
Family medicine resident at the University of Toronto and is now a practising family physician.
Dahlia
D
Balaban
Director of Research in the Schwartz/Reisman Emergency Medicine Institute.
Shelley
S
McLeod
Second-year medical student at the University of Toronto.
Sally
S
Carver
Director of the Schwartz/Reisman Emergency Medicine Institute and an emergency physician at Mount Sinai Hospital.
Bjug
B
Borgundvaag
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D002170:Canada; D006063:Chorionic Gonadotropin / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D005865:Gestational Age; D006801:Humans; D019095:Point-of-Care Systems; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging*; D055815:Young Adult
D006063:Chorionic Gonadotropin