Keywords
Pregnancy outcome
PROM
Preterm birth
Perinatal mortality
How to Cite
Abstract
Introduction: Pregnancy is a significant event in a woman’s life, and emotional attachment to the pregnancy and developing foetus may begin early in the first trimester. Bleeding during first trimester is a source of stress and anxiety to mothers because of the uncertainty of the outcome, lack of preventive measures and emotional significance of early pregnancy loss.
Objective: To determine pregnancy outcomes among women presenting with first trimester vaginal bleeding.
Methodology: This hospital-based descriptive longitudinal study was conducted at Kathmandu Medical College Teaching Hospital over a period of one year. Pregnant women presenting with vaginal bleeding within the first trimester (≤13 weeks) were enrolled. Maternal characteristics, pregnancy viability, obstetric complications, mode of delivery, and perinatal outcomes were analyzed using SPSS.
Results: Out of 220 women included, 136 (61.8%) had non-viable pregnancies and 84 (38.2%) had viable pregnancies. The mean maternal age was 28.89 ± 5.1 years and the mean gestational age at presentation was 8.44 ± 2.08 weeks. Among viable pregnancies, 40 (47.7%) delivered at term, 31 (36.9%) had preterm delivery, and 13 ( 15.4%) had mid-trimester abortion. Obstetric complications occurred in 55 (77.5%) of viable pregnancies, with prelabour rupture of membranes being the most common 34 (61.8%). Among 70 live births, 16 (22.5%) required NICU admission and there were four perinatal deaths.
Conclusion: First trimester vaginal bleeding is frequently associated with pregnancy loss and adverse maternal and perinatal outcomes. Even in viable pregnancies, close antenatal surveillance is warranted.
References
Kavyashree HS, Rajeshwari K. A study on pregnancy outcome in patients with first trimester vaginal bleeding. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2019 Mar 1;8(3):820-5. [Full Text | DOI]
Yakıştıran B, Yüce T, Söylemez F. First trimester bleeding and pregnancy outcomes: Case-control study. International Journal of Women’s Health and Reproduction Sciences. 2016 Jan;4(1):4-7. [Full Text | DOI]
Goldman JA, Ashkenazi J, Ben-David M, Feldberg D, Dicker D, Voliovitz I. First trimester bleeding in clinical IVF pregnancies. Human Reproduction. 1988 Aug 1;3(6):807-9. [PubMed | Full Text | DOI]
Wittels KA, Pelletier AJ, Brown DF, Camargo Jr CA. United States emergency department visits for vaginal bleeding during early pregnancy, 1993-2003. American journal of obstetrics and gynecology. 2008 May 1;198(5):523-e1. [PubMed | Full Text | DOI]
Berkowitz GS, Harlap S, Beck GJ, Freeman DH, Baras M. Early Gastational Bleeding and Pregnancy Outcome: A Multivariable Analysis. International journal of epidemiology. 1983 Jun 1;12(2):165-73. [PubMed | Full Text | DOI]
Yang J, Savitz DA, Dole N, et al. Predictors of vaginal bleeding during the first two trimesters of pregnancy. Paediatric and perinatal epidemiology. 2005 Jul;19(4):276-83. [PubMed | Full Text | DOI]
Batzofin JH, Fielding WL, Friedman EA. Effect of vaginal bleeding in early pregnancy on outcome. Obstetrics and gynecology. 1984 Apr 1;63(4):515-8. [PubMed | Full Text]
Axelsen SM, Henriksen TB, Hedegaard M, Secher NJ. Characteristics of vaginal bleeding during pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1995 Dec 1;63(2):131-4. [PubMed | Full Text | DOI]
Dighe M, Cuevas C, Moshiri M, Dubinsky T, Dogra VS. Sonography in first trimester bleeding. Journal of Clinical ultrasound. 2008 Jul;36(6):352-66. [PubMed | Full Text | DOI]
Amirkhani Z, Akhlaghdoust M, Abedian M, et al. Maternal and perinatal outcomes in pregnant women with first trimester vaginal bleeding. Journal of family & reproductive health. 2013 Jun;7(2):57. [PubMed | Full Text]
Ananth CV, Savitz DA. Vaginal bleeding and adverse reproductive outcomes: a meta‐analysis. Paediatric and perinatal epidemiology. 1994 Jan;8(1):62-78. [PubMed | Full Text | DOI]
Hertz JB, Heisterberg L. The outcome of pregnancy after threatened abortion. Acta obstetricia et gynecologica Scandinavica. 1985 Jan 1;64(2):151-6. [PubMed | Full Text | DOI]
Dongol A, Mool S, Tiwari P. Outcome of pregnancy complicated by threatened abortion. Kathmandu University Medical Journal. 2011;9(1):41-4. [PubMed | Full Text | DOI]
Mahajan M, Sharma P, Gupta S. Ultrasonographic evaluation of first trimester bleeding and its clinical assessment: A prospective study. JMSCR. 2019;7(6):116-9. [Full Text | DOI]
Bhatu JJ, Prajapati DS. A study of feto-maternal outcome in bleeding per vaginum in first trimester of pregnancy. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2020 Mar 1;9(3):1191-6. [Full Text | DOI]
Csapo AI, Pulkkinen MO, Wiest WG. Effects of luteectomy and progesterone replacement therapy in early pregnant patients. American journal of obstetrics and gynecology. 1973 Mar 15;115(6):759- 65. [PubMed | Full Text | DOI]