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Ultrasound Assessment of First-Trimester Bleeding

From the Gundersen Lutheran Medical Center, La Crosse, Wisconsin.

OBJECTIVE: To assess the outcome (to the end of the first trimester) of pregnancies with vaginal bleeding and the influence of ultrasound-acquired information on care and cost of care.

METHODS: A chart review was performed of 1,240 patients receiving care at an integrated medical center for threatened abortion from 1998–2000. Records from 715 patients with adequate follow-up data were reviewed and outcomes studied. Charges for outpatient and inpatient care were obtained from the data warehouse.

RESULTS: Main findings include that on endovaginal ultrasonography, 44% of the pregnancies were viable, of which 86% continued to the end of the first trimester and that of the 33% of pregnancies that were nonviable, 74% successfully miscarried without intervention. Charges for the care varied significantly, based on outcome and choice of site of care.

CONCLUSION: Endovaginal ultrasonography for the evaluation of early pregnancy bleeding has a significant effect on care decisions and costs.

LEVEL OF EVIDENCE: II-3