Study of outcome of pregnancy in patients with first-trimester bleeding per vaginum
Keywords:First-trimester, Pregnancy, Preterm birth, Vaginal bleeding
Background: To assess pregnancy outcome in women with threatened miscarriage in the first trimester. To study various maternal complication and outcome of labor in pregnancy affected by first-trimester bleeding.
Methods: This prospective study was carried out by institute from May 2013 to April 2014. 100 patients were included with a history of amenorrhea and urine pregnancy test positive with bleeding per vaginum in the first trimester.
Results: In this case series, 100 cases of first-trimester bleeding were studied. Majority of patients were multigravida (66%). In the present study, 40 patient (40%) had a history of previous abortion out of these 16 (40%) had non-viable outcome and 24 (60%) continue with the pregnancy beyond 20 weeks. Majority of patients (68%) presented with spotting, among those 59 (86.7%) had a favorable outcome and only 9 (13.3%) out of 68 patients were aborted. All 10 patients of heavy bleeding category aborted. 5 out of 22 patients of bleeding of moderate category aborted. First-trimester bleeding associated with pain has a poor outcome.
Conclusion: First-trimester bleeding is not only associated with miscarriage but also with a higher rate of pregnancy complications. First-trimester bleeding is associated with an increased risk of certain pregnancy-related complications namely placental abruption, preterm labor, delivery of low birth weight infants and preterm premature rupture of membrane.
Cunningham FG. Williams’s Obstetrics. 23rd Edition. New York: McGraw-Hill; 2010: 825-9.
Nyberg DA, Filly RA, Filho DL, Laing FC, Mahony BS. Abnormal pregnancy: early diagnosis by US and serum chorionic gonadotropin levels. Radiology. 1986;158(2):393-6.
Yazigi R, Saunders E, Gast M. Hormonal therapy during pregnancy. Contemp Ob Gyn. 1991;61 78.
Williams MA, Mittendorf R, Lieberman E, Monson RR. Adverse infant outcomes associated with first-trimester vaginal bleeding. Obstet Gynecol. 1991;78(1):14-8.
Kutteh W, Carr B. Diagnosis and management of recurrent pregnancy loss. Female Patient Q. 1993;18:85-98.
Davari-Tanha F, Shariat M, Kaveh M, Ebrahimi M, Jalalvand S. Threatened abortion: a risk factor for poor pregnancy outcome. Acta Med Iran. 2008;46:314-20.
Mulik V, Bethel J, Bhal K. A retrospective population-based study of primigravid women on the potential effect of threatened miscarriage on obstetric outcome. J Obstet Gynaecol. 2004;24(3):249-53.
Wijesiriwardana A, Bhattacharya S, Shetty A, Smith N, Bhattacharya S. Obstetric outcome in women with threatened miscarriage in the first trimester. Obstet Gynecol. 2006;107(3):557-62.
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. 1994:63(4):515-8.
Sipilä P, Hartikainen-Sorri AL, Oja H, Von Wendt L. Perinatal outcome of pregnancies complicated by vaginal bleeding. Br J Obstet Gynaecol. 1992;99:959 63.
Stirrat GM. Recurrent miscarriage: defination and epidemiology. Lancet. 1990;336:728-33.
Maso G, D’Ottavio G, De Seta F, Sartore A, Piccoli M, Mandruzzato G. First-trimester intrauterine hematoma and outcome of pregnancy. Obstet Gynecol. 2005;105(2):339-44.
Funderburk SJ, Guthrie D, Meldrum D. Outcome of pregnancies complicated by early vaginal bleeding. Br J Obstet Gynaecol. 1980;87(2):100-5.
Snell BJ. Assessment and management of bleeding in the first trimester of pregnancy. J Midwifery Womens Health. 2009;54:483-91.
Hasan R, Baird DD, Herring AH, Olshan AF, Jonsson Funk ML, Hartmann KE. Association between first-trimester vaginal bleeding and miscarriage. Obstet Gynecol. 2009;114(4):860-7.