Outcome of the First Trimester Threatened Miscarriage: Study of the Predicting Factors

Abstract

ABSTRACT: BACKGROUND:Threatened miscarriage is a distressing condition to both pregnant woman and gynecologist. It is important to predict the outcome of threatened miscarriage through maternal history, biochemical tests, and fetal ultrasound for patient counseling and to avoid delay in management.Study designA prospective multiple logistic regression analysis study.OBJECTIVE:To assess the power of factors which are maternal history (age, vaginal bleeding, parity and hypertension), biochemical tests (β-hCG & serum progesterone level) and fetal ultrasound (crown rump length& fetal heart rate) for predicting the outcome of pregnancy (fetal demise & ongoing pregnancy) complicated by threatened miscarriage between 7-11 wks and to determine the time interval from onset of symptoms to fetal demise development.PATIENTS AND METHODS:The study was carried out on 80 pregnant women at their 7-11 weeks of gestation suffering from vaginal bleeding attending Al-Elwiya Maternity Teaching hospital. They were subjected to ultrasound to confirm fetal viability, assay of serum progesterone and β-hCG levels and pain with bleeding scores. All these were repeated on weekly basis for four weeks follow up to monitor the pregnancy and identify the period to fetal demise (if happened). The data is gathered on questionnaire paper and then subjected to statistical study.RESULTS:The β-hCG (human chorionic gonadotrophin hormone) level was found to be the main predictor for pregnancy outcome (miscarriage/fetal demise & ongoing pregnancy) and highly statistically significant (P value<0.0012), followed by bleeding (p <0.002) and maternal age (p<0.01) respectively, while other variables (serum progesterone, fetal ultrasound, parity) showed no statistically significant effect (P value=0.47, 0.63, 1.146 respectively) on the risk of miscarriage/fetal demise. Serum progesterone level was highly significant in predicting ongoing pregnancy (P value=0.001)CONCLUSION:Measuring of beta hCG levels is found to be a good predictor for the outcome of the first trimester threatened miscarriage whether ends in to fetal demise or continuing pregnancy, while other factors like ultrasound, serum progesterone levels and parity are useful in assessing an ongoing pregnancy but have no power in predicting possibility of fetal demise. Also measuring the interval from the onset of bleeding to fetal demise development can be useful to avoid delaying pregnancy management.