Threatened Abortion: Prediction of Viability Based on Signs and Symptoms

Chung, T.K.H.; Sahota, Daljit Singh; Lau, Tze Kin; Mongelli, J.M.; Spencer, John; Haines, Christopher J.

doi:10.1111/j.1479-828x.1999.tb03129.x

Cited by 29 publications

(14 citation statements)

References 5 publications

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“…Several previous studies estimated the risk of miscarriage for women presenting to emergency or hospital care (9–11). Many women in such a sample would be presenting with a current miscarriage, and these studies exclude many pregnant women who experience bleeding but do not seek emergency care.…”

Section: Discussionmentioning

confidence: 99%

“…However, pregnant women reporting these symptoms can be reassured that their relative risk of miscarriage is not increased compared to the general population. Most previous studies have been unable to assess the effect of light bleeding or spotting because most were conducted in hospital or clinic-based populations, or based entirely on medical records, and such episodes come to clinical attention less frequently (8–11, 21). Furthermore, rigorous evaluation of the relationship between early pregnancy bleeding and first-trimester miscarriage requires enrollment early in pregnancy, which other population-based bleeding studies have not done (13, 14).…”

Section: Discussionmentioning

confidence: 99%

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Association Between First-Trimester Vaginal Bleeding and Miscarriage

Hasan

Baird

Herring

et al. 2009

Obstetrics &Amp; Gynecology

106

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Objective To estimate the strength of association between first-trimester bleeding and miscarriage, setting aside the bleeding at time of loss. Methods Women enrolled in a community-based pregnancy cohort study before or during early pregnancy. Detailed, first-trimester bleeding data were collected by telephone interview. Bleeding episodes proximal to miscarriage (within 4 days) were excluded. We used discrete-time hazard models to evaluate the association between bleeding and miscarriage. Models were adjusted for maternal age, prior miscarriage, and smoking. Exploratory regression tree analysis was used to evaluate the relative importance of other bleeding characteristics (duration, associated pain, color, timing). Results Of the 4510 participants, 1204 (27%) reported some first-trimester vaginal bleeding or spotting, and 517 miscarriages were observed. Eight percent of those with bleeding reported heavy bleeding episodes. When we evaluated any bleeding, including episodes of only spotting, the unadjusted relative odds (OR) of miscarriage for women with bleeding (n=1204) was 1.1 (95% confidence interval [CI] 0.9–1.3). However, women who reported heavy bleeding (n=97)had nearly three times the risk of miscarriage compared to women without bleeding during the first trimester (OR 3.0, 95% CI 1.9–4.6). Adjustment for covariates had little effect on estimates. Further analyses suggested that women with heavy bleeding accompanied by pain were the group accounting for most of the elevated risk. Conclusion Heavy bleeding in the first trimester, particularly when accompanied by pain, is associated with higher risk of miscarriage. Spotting and light episodes are not, especially if only lasting 1–2 days..

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association Between First-Trimester Vaginal Bleeding and Miscarriage

Hasan

Baird

Herring

et al. 2009

Obstetrics &Amp; Gynecology

106

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“…Pelvic examination findings conclusive for miscarriage are not present in the majority of women who have a non‐viable pregnancy. An open os is only found in 24% 6,43 of women who subsequently miscarry, and the presence of products of conception on speculum examination is an even more uncommon finding, present in 13% 43 . However, differentiating the state of the cervical os at times is not straightforward 8 .…”

Section: Discussionmentioning

confidence: 99%

Review article: The use of pelvic examination within the emergency department in the assessment of early pregnancy bleeding

Isoardi

2009

Emerg Medicine Australasia

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Early pregnancy bleeding is a common presentation in the emergency setting. Traditionally, its assessment relied on clinical findings, including pelvic examination. However in recent years, ultrasonography and quantitative beta human chorionic gonadotropin assays have gained prominence and are now first-line in diagnosing early pregnancy bleeding. Accordingly, the role of pelvic examination in the acute setting has been increasingly questioned. This article reviews the evidence for the role of pelvic examination in the assessment of early pregnancy bleeding in the ED. A Medline search was conducted and 43 articles were included in this review. Applicable research is largely observational and of a low level of evidence. However, available data indicate that the role of pelvic examination in the assessment of early pregnancy bleeding is limited, providing that there is prompt access to transvaginal ultrasound examination. Pelvic examination does not provide further diagnostic information over ultrasonography used in conjunction with beta human chorionic gonadotropin assays. The routine use of pelvic examination is not supported by the literature. However, when ultrasonography and beta human chorionic gonadotropin testing are unavailable or the results inconclusive, pelvic examination should be considered. Assessment in these instances must focus on identifying possible life-threatening conditions, such as ectopic pregnancy, as well as determining the safety of discharge pending definitive assessment. Speculum examination is indicated in those presenting with severe bleeding or hypotension as removal of obstructing endocervical products can be a crucial resuscitative measure.

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“…Chung et al [18] have shown that clinical assessment of threatened miscarriage is unreliable in most cases and should be superseded by an ultra-sonography assessment. A history of having passed a tissue mass, the presence of products of conception in the vagina and an open cervix were the only signs or symptoms associated with greater than a 90% chance that the pregnancy was non-viable.…”

Section: Discussionmentioning

confidence: 99%