Many women experience bleeding in their first trimester of pregnancy. This is often a source of great stress, as patients worry if it’s an early sign of pregnancy failure, or miscarriage. So when a patient seeks emergency care because of vaginal bleeding, their main concern is about miscarriage.
However, the focus for clinicians is whether the patient has an ectopic pregnancy, where the fetus grows outside the uterus; or something else potentially dangerous to her health. They are not as concerned about a miscarriage; which we all accept as an inherent risk of pregnancy and does not portend any danger to patients.
Once an ectopic or molar pregnancy is ruled out, physicians are typically finished with their assessment. But the patient and her family are unhappy and stressed because they don’t have the answers they want. They still don’t know if she has miscarried.
New technology to reduce uncertainty
Dr. Amir Mor of GENESIS and Dr. Hugh Taylor of the Yale Fertility Center have developed a test to assess the passage of fetal tissue in real time. In simpler terms, this means they can determine immediately if the woman is miscarrying, without waiting. With these rapid results, the physician is better able to help the patient because accurate treatment can start immediately. She or he may also able to reassure the patient worried about the bleeding and what it might mean.
Without this new technology, if an ectopic pregnancy is suspected, physicians will treat the patient with methotrexate. Patients treated with methotrexate must temporarily delay fertility treatment for a few months, since there may be traces of this medicine still in her body. But if the bleeding is not caused by an ectopic pregnancy, treating with methotrexate is an unnecessary and frustrating delay.
How does the test work?
A fetus makes alpha-fetoprotein (AFP). The levels of AFP are high in fetal amniotic blood. When a woman comes in with vaginal bleeding, AFP that is in the blood can be measured to determine if the source of the blood is fetal or maternal.
High levels of AFP mean the source is from the fetus; low levels of AFP mean the source is maternal.
With this test, the patient and physician will know why she is bleeding the same day. This avoids unnecessary doctor visits, ultrasounds and repeat bloodwork.
This test will be exclusively available at GENESIS and Yale University.