Variables Associated With Favorable Obstetrical Outcomes in Early Pregnancy Bleeding in the Emergency Department
Notice bibliographique
Résumé
Background Vaginal bleeding in early pregnancy is a frequent emergency department presentation and is associated with various obstetrical outcomes. Despite this, there has been limited research on the variables that predict less-than-preferred obstetrical outcomes in these cases. This study aims to identify predictors of preferred obstetrical outcomes for women presenting to the emergency department with early pregnancy bleeding. Methods We conducted a retrospective review of health records from an emergency department at a Canadian tertiary care center. Pregnant females presenting with vaginal bleeding before 20 weeks gestation were included. Variables analyzed included maternal age, gravidity, parity, hemoglobin levels, Rh status, cramping, socioeconomic status, and ultrasound findings. The primary outcome was a preferred outcome, defined as a full-term live birth (≥37 weeks). Less-preferred outcomes included miscarriage, preterm birth, and stillbirth. Point-of-care ultrasound and radiology ultrasound findings were also evaluated. Results A total of 422 patients were screened, and 180 were included in the analysis. Overall, 75 (41.7%) patients had a preferred outcome, while 105 (58.3%) had a less-preferred outcome. The strongest predictor of a preferred outcome was the presence of a live intrauterine pregnancy with fetal heartbeat on ultrasound, with a preferred outcome rate of 74.5% (56/76) (95% CI 59.8-88.7; p < 0.01) on point-of-care ultrasound (POCUS), and 100% (65/65); p = 0.04 for radiology-performed ultrasound. In contrast, 80.8% (21/26) of patients with findings other than a live intrauterine pregnancy on POCUS, and 100% (88/88) on radiology-performed ultrasound had a less-preferred outcome. Cramping with bleeding was associated with a higher rate of less-than-preferred outcomes (62.1%, 77/124; 95% CI 54.2-71.1; p = 0.07). Socioeconomic status was not a significant predictor, with similar outcomes above and below the poverty line. Anemia was associated with a 100% non-live birth rate, although only 5 patients were anemic. Conclusion Identification of a live intrauterine pregnancy on ultrasound is a strong predictor of a preferred outcome in early pregnancy bleeding. POCUS has the advantage of being immediately available, whereas radiology-performed ultrasound may be more definitive as a predictor. Cramping and anemia may also be associated with less-preferred outcomes, though further research is needed to confirm these findings. These predictors may help guide clinical decision-making and improve counseling for patients presenting to the emergency department with early pregnancy bleeding.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».