Factors influencing pregnancy outcome in women with vaginal bleeding before midpregnancy: a prospective case control study
Keywords:Vaginal bleeding, Pregnancy complications, Obstetric outcome, Subchorionic hemorrhage
Background: Pregnancy complications are observed to be higher among women with first trimester bleeding compared to those without bleeding. We intended to compare the obstetric outcome based on details of bleeding episodes, i) in groups with spotting, bleeding and brown discharge; ii) in those with or without subchorionic haemorrhage; and iii) between single versus recurrent episodes of bleeding.
Methods: We conducted a prospective case control study involving the women enrolled for antenatal care before 20 weeks of gestation. Information was collected regarding the details of bleeding, the pregnancy complications and the perinatal outcome. The outcome variables were analysed as per the study objectives using SPSS version 16.0.
Results: Pregnancies complicated by bleeding before 20 weeks of gestation were associated with the significant increase in preterm premature rupture of the membranes [P 0.045; RR 4.8 (95% CI 1.5-15)], intrauterine growth restriction [P 0.039; RR 2.5(95% CI 1.1-6.3)], oligohydramnios [RR 4.3 (95% CI 2-9)], hypertension [RR 1.8 (95% CI 1.07-3.09)], small for gestational age babies [P 0.047; RR 2.7 (95% CI 1.2-6.1)] and NICU admissions [P 0.016; RR 2.7 (95% CI 1.1-6.5)]. Fresh bleeding/ spotting were associated with increased pregnancy complications (P 0.048) compared to brownish discharge. Presence of subchorionic hemorrhage on ultrasound in women with vaginal bleeding was associated with increased pregnancy complications (P 0.044). No difference in terms of complications, mean gestational age and mean birth weight was noted depending on the number of episodes of bleeding.
Conclusions: Fresh bleeding and presence of subchorionic hemorrhage predict a poor pregnancy outcome in women with bleeding before 20 weeks of pregnancy.
Funderburk SJ, Guthrie D, Meldrum D. Outcome of pregnancies complicated by early vaginal bleeding. BJOG. 2005;87(2):100-5.
Saraswat L, Bhattacharya S, Maheshwari A, Bhattacharya S. Maternal and perinatal outcome in women with threatened miscarriage in first trimester. BJOG. 2010;117(3):245-57.
Narang A, Chaudhuri MK, Kumar P. Small for gestational age babies: Indian scene. Indian J Pediatr. 1997;64(2):221-4.
Biesheuvel CJ, Vergouwe Y, Oudega R, Hoes AW, Grobbee DE, Moons KG. Advantages of the nested case-control design in diagnostic research. BMC Med Res Methodol. 2008;8:48.
Sun L, Tao F, Hao J, Su P, Liu F, Xu R. First trimester vaginal bleeding and adverse pregnancy outcomes among Chinese women: from a large cohort study in China. J Matern Fetal Neonatal Med. 2012;25(8):1297-301.
Yang J, Hartmann KE, Savitz DA, Herring AH, Dole N, Olshan AF, et al. Vaginal bleeding during pregnancy and preterm birth. Am J Epidemol. 2004;160:118-25.
Hossain R, Harris T, Lohsoonthorn V, Williams MA. Risk of preterm delivery in relation to vaginal bleeding in early pregnancy. Eur J Obstet Gynecol Reprod Biol. 2007;135:158-63.
Sharami SH, Faraji Darkhaneh R, Zahiri Z, Milani F, Asgharnia M, Shakiba M, et al. The relationship between vaginal bleeding in the first and second trimester of pregnancy and preterm labor. Iran J Reprod Med. 2013;11(5):385-90.
Lykke JA, Dideriksen KL, Lidegaard O, Langhoff-Roos J. First-trimester vaginal bleeding and complications later in pregnancy. Obstet Gynecol. 2010;115(5):935-44.
Batzofin JH, Fielding WL, Friedman EA. Effect of vaginal bleeding in early pregnancy on outcome. Obstet Gynecol. 1984;63:515-8.
Wijesiriwardana A, Bhattacharya S, Shetty A, Smith N, Bhattacharya S. Obstetric outcome in women with threatened miscarriage in first trimester. Obstet Gynecol. 2006;107:557-62.
Berkowitz GS, Harlap S, Beck GJ, Freeman DH, Balas M. Early gestational bleeding and pregnancy outcome: a multivariant analysis. Int J Epidemiol. 1983;12:165-73.
Maso G, D’Ottavio G, Seta F, Sartore A, Piccoli M, Mandruzzato G. First trimester intrauterine hematoma and outcome of pregnancy. Obstet Gynecol. 2005;105(2):339-44.
Nagy S, Bush M, Stone J, Lapinski RH, Gardo S. Clinical significance of subchorionic and retroplacental hematoma detected in first trimester of pregnancy. Obstet Gynecol. 2003;102(1):94-100.