The Perinatal Outcome of Pregnancies Complicated by Vaginal Bleeding in First and Second Trimesters

Abstract

This is a prospective cohort study conduced in the period from June 2003 to June 2004 . There were 308 patients attending the out patient , referred and casualty clinics in KTH and SUH . There were 103 cases and 205 controls . We studied the effect of bleeding in the 1st and 2nd trimesters on the perinatal outcome . we looked specifically for the risk of prematurity , intrauterine growth restriction , antepartum haemorrhage and the perinatal morbidity and mortality . Other risks also appeared in the study including the risk of congenital malformations and the association with a previous history of infertility . Those patients were followed from the time of vaginal bleeding which should be at 24 week gestational age or less . The pregnancy should proceed to the third trimester . Patients are seen regularly and at time of complications till delivery and discharge jointly with the neonatologist . IV The statistical analysis showed an increased risk of preterm labour and delivery which was statistically significant (P= .003). It was even more significant for those who had more than one episode of bleeding compared to the control group . For growth restriction , the study revealed astatistically significant risk of baby born at term with growth restriction compared to the control group. Also there was an increased risk of perinatal morbidity and mortality among cases with early vaginal bleeding compared to controls ( P= .001). Regarding the risk of antepartum haemorrahge , The P value = .004 , showing an increased risk of all forms of APH including unexplained antepartum haemorrahge . Also there was an association between history of infertility and the risk of bleeding in early pregnancy . There was no association between previous miscarriages and the occurrence of bleeding in early pregnancy in the future .