Predictive value of the presence of an embryonic heartbeat for live birth: comparison of women with and without recurrent pregnancy loss.

OBJECTIVE

To determine the predictive value of an embryonic heart rate (EHR) for a live birth in women with and without a history of recurrent pregnancy loss (RPL).

DESIGN

Prospective cohort study with concurrent controls.

SETTING

A subspecialty clinic for couples with RPL.

PATIENT(S): Three hundred pregnant women who previously had been diagnosed with RPL, followed prospectively compared with 300 age-, race-, and gestational age-matched pregnant control women.

INTERVENTION(S): Transvaginal sonography between 6 to 8 weeks of gestation.

MAIN OUTCOME MEASURE(S): The EHR was determined between 6 and 8 weeks of gestation by transvaginal sonography. Obstetrical history and current pregnancy outcome were evaluated.

RESULT(S): Data were analyzed by using the two-tailed t test and Fisher's exact test. In women with RPL, an EHR predicted a successful live birth in 246 (82%) of 300, compared with 294 (98%) of 300 in control women. The mean (+/- SD) EHR from successful pregnancies in the control group (143.2 +/- 20.8 beats per minute) was significantly higher than the mean in women with a history of RPL (131.4 +/- 22.9 beats per minute).

CONCLUSION(S): An EHR in women with RPL is associated with a live birth rate of 82% and is significantly lower than EHR in controls. Clinicians should use this information to counsel patients with RPL.