Ultrasound assessment of first-trimester bleeding.

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.