VAGINAL BLEEDING AND EARLY-PREGNANCY OUTCOME IN AN INFERTILE POPULATION

Objective: Our purpose was to determine the prognostic value of vagina l bleeding in early pregnancy outcome as well as to analyze the role o f cardiac activity in predicting pregnancy viability in the presence o f vaginal bleeding. Study Design: This was a cohort study of pregnanci es obtained using either assisted,reproductive technology (ART) or rou tine infertility treatment (RIT). Two hundred twenty-eight pregnant wo men were divided into two groups based on the presence or absence of v aginal bleeding. Successive measurements of beta-hCG levels were obtai ned every 2 days, starting on day 14 after ovulation or embryo transfe r All pregnancies underwent weekly transvaginal ultrasound (UTZ) exami nations beginning or 2 day 21. The occurrrence of vaginal bleeding was monitored weekly. Results: Seventy of the 228 patients (31%) had blee ding in early pregnancy, resulting in 31 (44%) pregnancy losses, Only 22 pregnancy losses (14%) were observed in 158 patients who did not ha ve bleeding (P < 0.001). The abortion rate for the bleeding versus non bleeding groups was 35 and 9%, respectively (P < 0.001). Vaginal bleed ing was associated with a higher abortion rate in pregnancies followin g RIT than ART (51 vs 8%; P < 0.001). Fetal cardiac activity was noted by vaginal ultrasound in 189 patients. In this subpopulation, bleedin g was also associated with a higher abortion rate than that in the non bleeding group (17 vs 4%; P < 0.001). However this higher incidence wa s observed only in pregnancies following RIT, not ART (28 vs 5%; P < 0 .001). Conclusions: Although bleeding significantly decreased the chan ce of a normal pregnancy outcome, more than 50% of the pregnancies did progress to term. The presence of cardiac activity in this population as a sign of fetal viability offered a better pregnancy prognosis. Ho wever the predictive value of fetal cardiac activity was reduced in th e presence of vaginal bleeding in an infertile population treated with RIT.