Juliano Michael L, Sauter Bettina M
Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
J Emerg Med. 2012 Sep;43(3):417-22. doi: 10.1016/j.jemermed.2011.05.021. Epub 2011 Jun 29.
Pregnant women commonly present to the Emergency Department (ED) for evaluation during their first trimester. These women have many concerns, one of which is the viability of their pregnancy and the probability of miscarriage.
We sought to determine fetal outcomes of women with an indeterminate ultrasound who present to the ED during the first trimester of pregnancy.
A retrospective analysis of consecutive ED patient encounters from December 2005 to September 2006 was performed to identify patients who were pregnant and who had an indeterminate transvaginal ultrasound performed by an emergency physician or through the Radiology Department during their ED visit. Demographic data, obstetric/gynecologic history, and presenting symptoms were recorded onto a standardized patient chart template designed to be used for any first trimester pregnancy. Outcomes (spontaneous abortion, ectopic pregnancy, and 20-week gestation) were determined via computerized medical records.
During the study timeframe, a total of 1164 patients were evaluated in the ED during the first trimester of their pregnancy; 359 patients (30.8%) met inclusion criteria and had a diagnosis of indeterminate ultrasound. Outcome data were obtained for 293 patients. Carrying the pregnancy to ≥20 weeks occurred in 70 patients (23.9%). Spontaneous abortion occurred in 193 women (65.9%), and 30 women (10.2%) were treated for an ectopic pregnancy. Total fetal loss incidence was 89.2% in patients presenting with any vaginal bleeding, compared to 34.7% in patients with pain only.
Indeterminate ultrasounds in the setting of first trimester symptomatic pregnancy are indicative of poor fetal outcomes. Vaginal bleeding increased the risk of fetal loss. These data will assist emergency physicians in counseling women in the ED who are found to have an indeterminate ultrasound.
怀孕头三个月的孕妇常前往急诊科进行评估。这些女性有诸多担忧，其中之一是其妊娠的存活能力及流产几率。
我们试图确定怀孕头三个月前往急诊科且超声检查结果不确定的女性的胎儿结局。
对2005年12月至2006年9月急诊科连续接诊患者进行回顾性分析，以识别怀孕且在急诊科就诊期间由急诊医生或通过放射科进行经阴道超声检查结果不确定的患者。人口统计学数据、妇产科病史及就诊症状被记录在专为任何怀孕头三个月设计的标准化患者病历模板上。结局（自然流产、宫外孕及妊娠20周）通过计算机化病历确定。
在研究时间段内，共有1164名孕妇在怀孕头三个月到急诊科就诊；359名患者（30.8%）符合纳入标准且超声检查结果不确定。获取了293名患者的结局数据。70名患者（23.9%）妊娠至≥20周。193名女性（65.9%）发生自然流产，30名女性（10.2%）接受了宫外孕治疗。有任何阴道出血症状的患者胎儿总丢失率为89.2%，而仅有疼痛症状的患者为34.7%。
怀孕头三个月有症状妊娠情况下超声检查结果不确定预示着胎儿结局不佳。阴道出血增加了胎儿丢失风险。这些数据将有助于急诊医生为在急诊科被发现超声检查结果不确定的女性提供咨询。
