USE OF ULTRASOUND TO RISK-STRATIFY PREGNANCY …



USE OF ULTRASOUND TO RISK-STRATIFY PREGNANCY OUTCOME IN EMERGENCY DEPARTMENT PATIENTS WITH FIRST TRIMESTER VAGINAL BLEEDING

HEE SUN CHOI

Mentor: John Christian Fox, MD, RDMS, FACEP

Ultrasound is an excellent tool to use to obtain exceptional information about the status of the conceptus, and we studied how the information can be used to predict pregnancy outcomes in patients with vaginal bleeding. Vaginal bleeding during the first trimester of pregnancy can be a result of spontaneous abortion, gestational trophoplastic disease, implantation bleeding, cervical ectropion, cervicitis or ectopic pregnancy. It is essential to include all diagnoses, due to potential life threat and threatened abortion. Pelvic ultrasonography is considered the best procedure to evaluate every pregnant patient with vaginal bleeding in early pregnancy, due to there being no evidence of risk to mother or fetus and immediate test results, while providing five potential diagnoses in such situations. For example, pelvic ultrasonography can reveal ND IUP (no definitive intrauterine pregnancy), IUP (intrauterine pregnancy), LIUP (live intrauterine pregnancy), ABN IUP (abnormal intrauterine pregnancy), and ectopic pregnancy. Finding ND IUP, IUP and LIUP indicates potentially viable pregnancies, while finding ABN IUP and ectopic pregnancy signify non-viable pregnancies. A total of 182 women were enrolled and, of the 136 that met inclusion criteria, 38 (28%) carried to term and delivered live babies. Of the 38 live births, 31 (82%) were noted to have a documented LIUP at the time of the emergency department visit. The other findings included IUP (13%) and ND IUP (5%). None of the ABN IUP resulted in a live birth. Therefore, in women with first trimester vaginal bleeding, the likelihood of carrying the pregnancy to term appears to be related to the findings of the pelvic ultrasound performed.

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