Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA USA.
Am J Emerg Med. 2012 Mar;30(3):399-404. doi: 10.1016/j.ajem.2010.12.021. Epub 2011 Feb 5.
The possibility of spontaneous miscarriage is a common concern among pregnant women in the emergency department (ED).
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").
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.
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.
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.
在急诊科（ED），孕妇普遍担心自然流产的可能性。
本研究旨在确定因第一孕期腹痛或阴道出血而在 ED 接受评估且超声显示子宫内妊娠（IUP）有孕囊（“卵黄囊 IUP”）的孕妇的胎儿结局。
对 2005 年 12 月至 2006 年 9 月连续的 ED 病历进行回顾性图表审查，确定存在卵黄囊 IUP 的患者。获取人口统计学数据、产科/妇科病史和临床表现。通过计算机记录确定结局。胎儿丢失通过β-人绒毛膜促性腺激素下降或病理标本诊断。活产通过 20 周超声或分娩诊断。
本研究共纳入 131 例患者。其中 14 例失访（12%），117 例患者就诊。在 117 例女性中，82 例至少将妊娠维持至 20 周。35 例流产。根据主要症状的胎儿丢失率如下：仅腹痛 46 例中有 8 例，仅阴道出血 34 例中有 14 例，阴道出血伴腹痛 37 例中有 13 例。
70%在 ED 诊断为卵黄囊 IUP 的女性将妊娠维持至至少 20 周。其余女性（30%）发生胎儿丢失。与仅腹痛的女性相比，阴道出血（伴或不伴疼痛）增加了胎儿丢失率。这些数据将有助于急诊医生为有症状的第一孕期妊娠的女性提供咨询。
