Predictive value of the presence of an embryonic heartbeat for live birth: Comparison of women with and without recurrent pregnancy loss

Objective

To determine the predictive value of an embryonic heart rate (EHR) for a live birth in women with and without a history of recurrent pregnancy loss (RPL).

Design

Prospective cohort study with concurrent controls.

Setting

A subspecialty clinic for couples with RPL.

Patient(s)

Three hundred pregnant women who previously had been diagnosed with RPL, followed prospectively compared with 300 age-, race-, and gestational age–matched pregnant control women.

Intervention(s)

Transvaginal sonography between 6 to 8 weeks of gestation.

Main outcome measure(s)

The EHR was determined between 6 and 8 weeks of gestation by transvaginal sonography. Obstetrical history and current pregnancy outcome were evaluated.

Result(s)

Data were analyzed by using the two-tailed t test and Fisher's exact test. In women with RPL, an EHR predicted a successful live birth in 246 (82%) of 300, compared with 294 (98%) of 300 in control women. The mean (± SD) EHR from successful pregnancies in the control group (143.2 ± 20.8 beats per minute) was significantly higher than the mean in women with a history of RPL (131.4 ± 22.9 beats per minute).

Conclusion(s)

An EHR in women with RPL is associated with a live birth rate of 82% and is significantly lower than EHR in controls. Clinicians should use this information to counsel patients with RPL.

Key words:  Recurrent pregnancy loss, embryonic heart rate, ultrasonography