Perinatal Outcome in Cases with Bleeding during First and Early Second Trimester
Background: Bleeding during first half of pregnancy
mostly originates from placenta, some abort, others are at risk of
complications. Objective: Study was done to know perinatal outcome
with bleeding up to 20 weeks in singleton pregnancy. Material
Methods: Subjects were 1020, equal controls managed over 2 years,
435 had viable pregnancy at admission, 135 excluded, 300 followed
for perinatal outcome, 99 (19.52% up to 10 weeks), 201 (39.18% of
11-20 weeks). Results: Hypertensive disorders occurred in 24% cases
of bleeding within 10 weeks, 22% 11-20 weeks 14.79% controls,
placenta previa 4% in 10 weeks, 0.9% 11-20 weeks, 0.97% controls,
prelabor rupture of membranes in 16%, 7.45% controls. 20% up to 10
weeks, 35% 11-20 weeks, 18% controls had fetal growth restriction,
34.34% up to 10 weeks 30.35% of 11-20 weeks 17.17% controls had
preterm births, perinatal mortality rate in study was 118.62, in
controls 68.16 (Uneventful pregnancy in 13.52% study, 46.11%
controls). Conclusion: Once bleeding occurs, one third continue
pregnancy, maternal neonatal outcome gets affected with variations
in cases of bleeding within first 10 weeks & 11-20 weeks.
[1] Buck C, James MG, Henry TR. Bleeding in early pregnancy, its causes
and consequences. Br J ObstetGynaecol 1996;56:290-2.
[2] Das AG, Gopalan S, Dhaliwal LK. Fetal growth and perinatal outcome
of pregnancies continuing after threatened abortion .Aust N Z J
ObstetGynaecol 1996;36:135-9.
[3] Agrawal CR, Gupta RK. Effect of vaginal bleeding in early pregnancy
on perinataloutcome. Obstet and Gynecol 2000; 63:515-8.
[4] Bhattacharya CR, Singh DG, Gupta GH: Risk factors for bleeding in
first 20 weeks of pregnancy and pregnancy outcome. Br J Obstet
Gynaecol 2002, 86:846-3
[5] Sharma AK, Dutta DR. The prognosis of pregnancies complicated by
bleeding in first half.Acta obstet Gynecol Scand 2003;20:45-9.
[6] Mitra KL, Stevenson DR. Threatened abortion and its maternal and fetal
implications. Br J Obstet Gynaecol 2004; 69:325-9.
[7] Weiss DR, MichealKF,NicholasDS.Complications of pregnancies with
bleeding in first 20 weeks. Obstet Gynecol 2005; 46: 82-8.
[8] Alexander L J; Lehrmann D K ; 0jvind L ; Jens LR First-Trimester
Vaginal Bleeding and Complications Later in Pregnancy, Obstetrics &
Gynecology: 2010 ; 115 ; 5; 935-944
[9] Dadkhan F, Kashanian M, Eliasi G. A comparison between the
pregnancy outcome in women both with or threatened abortion. Early
Hum Dev. 2010;86(3):193-6.
[10] Strobino B, Pantel -Silverman J. Gestational vaginal bleeding and
pregnancy outcome. Am J Epidemiol 1989;129:806-15.
[11] Gupta TV, Verma SK, Premi HK, Thakur S, Gupta KB, Randhawa I .
Perinatal outcome of pregnancies complicated by threatened abortion. J
Ind Med Assoc 1990;92:365-5
[12] Juarv Y, KE Hartmann, DA Stavitz, AH Herringi N Dole,AFOlshanet al
.Vaginal bleeding during pregnancy and preterm birth, Am J Epidemiol
2004; 160:118-125.
[13] Puscheck E, Pradhan A. Suzanne R. Trupin "Early Pregnancy Loss."
eMedicine. 2010. Medscape.
<http://emedicine.medscape.com/article/overview>.
[14] Cunningham SR.Grant DK, Frank DA. Threatened abortion and its
outcome. . Br J Obstet Gynaecol2001 ;85:1-8.
[15] BenHaroush LV, Pearlstone MM. Prediction of outcome in pregnancies
complicated by bleeding in first trimester. Am J Obstet Gynaecol
2003;165:1423-4
[16] Verma SK, Gupta TV, Premi HK, Thakur S, Gupta KB, Randhawa I.
Perinatal outcome of pregnancies complicated by threatened abortion. J
Ind Med Assoc 1993;92:365-8.
[17] Malik TR. The implication of a low implantation of the placenta
detected by ultrasonography in early pregnancy. Acta Obstet Gynecol
Scand 2004,; 60;265-9.
[18] Ball RH, Ade CM, Schoenborhn JA, Crane JP. The clinical significance
ofultrasonographically detected subchorionic hemorrhages. Am J Obstet
Gynaecol 1996;174:996-1002.
[19] Norwitz ER, Schust DJ, Fisher SJ. Implantation and the survival of
early pregnancy. N Engl J Med 2001;345:1400-8.
[20] Gordon Y B, Lewis J D, Pendlebury D J, Leighton M. Assessment of
outcome in threatenedabortion. Lancet 2004; 1:1001-3.
[21] Stein Z, Kline J, Susser M. Induced abortion and the chromosomal
characteristics of subsequent miscarriages. Am J Epidemiol 1999;
123:1066-79.
[22] Rai R, Clifford K, Regan L. Early pregnancy bleeding and suboptimal
perinatal outcomes .Acta obstet Gynecol Scand 1999;10:35-9.
[23] Sipila P, Hartikainen-Sorri AL. Perinatal outcome of pregnancy
complicated by vaginal bleeding. Br J Obstet Gynaecol 2000;99:959-63.
[24] Freeman SA, Charles DR, Griffth SD. Factors underlying preterm
labour. Obstet Gynecol2001; 74:52-9.
[25] Hertz JB.Anderson KG. The outcome of pregnancy after threatened
abortion. Acta Obstet Gynecol Scand 1985; 6:151-6.
[26] Williams MA, Mittendorf R, Leiberman E, Monson RR. Adverse
outcomes of pregnancy associated with first trimester vaginal bleeding
.Obstet Gynecol 1991; 78:14-8.
[27] Jones WR, Chapman MG, Furness ET.Significance of the ultrasound
location of placental site in early pregnancy. Br J Obstet Gynaecol
.1979; 86:84-8.
[28] Haddow JE, Knight GJ, Kloza EM, Palomaki GE. Alpha fetoprotein ,
vaginal bleeding and pregnancy risk. Br J Obstet Gynaecol
.1986;93:589-93.
[29] Pedersen JF, Mantoni M. Fetal growth delay in threatened abortion : an
ultrasound study. Br J Obstet Gynaecol 1982 89;525: 9.
[30] Jandial WD, Malik GH. Factors responsible for early pregnancy
bleeding.Obstet Gynecol 1978;68:14-8.
[31] Whittaker M, Pedersen JF. Intrauterine haematoma : An ultrasonic study
of threatened abortion. Br J Obstet Gynaecol 1983;88:47-51.
[32] James G A, Field HJ. Prediction of outcome in pregnancies complicated
by bleeding Acta Obstet Gynecol Scand 1987; 49:89-5.
[33] Williams MA, Mittendorf R, Leiberman E, Monson RR. Adverse
outcomes of pregnancy associated with first trimester vaginal bleeding
.Obstet Gynecol 1996;78:14-8.
[34] Bromley B, Bennett GL, Lieberman E, Benacerraf BR. Subchorionic
hemorrhage in first-trimester. Lancet 1996;200:803-6.
[35] OrnoyA ,Benady S, Kohen-Raz R. Association between maternal
bleeding during gestation and congenital anomalies in the offspring. Am
J Obstet Gynecol 1976;124:474-8.
[36] Berkowitz GS, Harlap S, Beck GJ :Early gestational bleeding and
pregnancy outcome. Int JEpidemiol 1983;12:165-73.
[37] Arafa M, Abdel-Fataah M, Zeid HA, el-Khouly A. Outcomes of
pregnancies complicated by early vaginal bleeding. East Mediterr Health
J. 2000;6(2-3):457-64.
[38] Shapiro S, Abramowicz M. Pregnancy outcome correlates identified
through medical record based information. Am J Public Health
1969;59:1629-50.
[39] Holmes LB, Simpson JL, Mills JL. Low fetal loss rates after ultrasound
proved viability in early pregnancy. JAMA 1999; 258:2555,.
[40] Stevenson HD, Tapanainen J, HuhtaniemiI : Plasma hCG levels in
patients with bleeding in the first and second trimesters of pregnancy. Br
J Obstet Gynaecol 1950; 56: 82-9.
[41] Copper GH, Grace DF, Micheal KJ. Ultrasonography and bleeding in
early pregnancy.Am J Obstet Gynecol 1981;16:136-9 .
[42] Green DA, David SR, Robinson FR. Pregnancy outcome after bleeding
in early pregnancy. Acta Obstet Gynecol Scand 1990;64:151-64
[43] Nagy S, Bush M, Stone J, Lapinski RH, Gardo S. Clinical significance
of subchoronic and retroplacental hematomas detected in the first
trimester of pregnancy. Obstet Gynecol 2003;102:94-100.
[1] Buck C, James MG, Henry TR. Bleeding in early pregnancy, its causes
and consequences. Br J ObstetGynaecol 1996;56:290-2.
[2] Das AG, Gopalan S, Dhaliwal LK. Fetal growth and perinatal outcome
of pregnancies continuing after threatened abortion .Aust N Z J
ObstetGynaecol 1996;36:135-9.
[3] Agrawal CR, Gupta RK. Effect of vaginal bleeding in early pregnancy
on perinataloutcome. Obstet and Gynecol 2000; 63:515-8.
[4] Bhattacharya CR, Singh DG, Gupta GH: Risk factors for bleeding in
first 20 weeks of pregnancy and pregnancy outcome. Br J Obstet
Gynaecol 2002, 86:846-3
[5] Sharma AK, Dutta DR. The prognosis of pregnancies complicated by
bleeding in first half.Acta obstet Gynecol Scand 2003;20:45-9.
[6] Mitra KL, Stevenson DR. Threatened abortion and its maternal and fetal
implications. Br J Obstet Gynaecol 2004; 69:325-9.
[7] Weiss DR, MichealKF,NicholasDS.Complications of pregnancies with
bleeding in first 20 weeks. Obstet Gynecol 2005; 46: 82-8.
[8] Alexander L J; Lehrmann D K ; 0jvind L ; Jens LR First-Trimester
Vaginal Bleeding and Complications Later in Pregnancy, Obstetrics &
Gynecology: 2010 ; 115 ; 5; 935-944
[9] Dadkhan F, Kashanian M, Eliasi G. A comparison between the
pregnancy outcome in women both with or threatened abortion. Early
Hum Dev. 2010;86(3):193-6.
[10] Strobino B, Pantel -Silverman J. Gestational vaginal bleeding and
pregnancy outcome. Am J Epidemiol 1989;129:806-15.
[11] Gupta TV, Verma SK, Premi HK, Thakur S, Gupta KB, Randhawa I .
Perinatal outcome of pregnancies complicated by threatened abortion. J
Ind Med Assoc 1990;92:365-5
[12] Juarv Y, KE Hartmann, DA Stavitz, AH Herringi N Dole,AFOlshanet al
.Vaginal bleeding during pregnancy and preterm birth, Am J Epidemiol
2004; 160:118-125.
[13] Puscheck E, Pradhan A. Suzanne R. Trupin "Early Pregnancy Loss."
eMedicine. 2010. Medscape.
<http://emedicine.medscape.com/article/overview>.
[14] Cunningham SR.Grant DK, Frank DA. Threatened abortion and its
outcome. . Br J Obstet Gynaecol2001 ;85:1-8.
[15] BenHaroush LV, Pearlstone MM. Prediction of outcome in pregnancies
complicated by bleeding in first trimester. Am J Obstet Gynaecol
2003;165:1423-4
[16] Verma SK, Gupta TV, Premi HK, Thakur S, Gupta KB, Randhawa I.
Perinatal outcome of pregnancies complicated by threatened abortion. J
Ind Med Assoc 1993;92:365-8.
[17] Malik TR. The implication of a low implantation of the placenta
detected by ultrasonography in early pregnancy. Acta Obstet Gynecol
Scand 2004,; 60;265-9.
[18] Ball RH, Ade CM, Schoenborhn JA, Crane JP. The clinical significance
ofultrasonographically detected subchorionic hemorrhages. Am J Obstet
Gynaecol 1996;174:996-1002.
[19] Norwitz ER, Schust DJ, Fisher SJ. Implantation and the survival of
early pregnancy. N Engl J Med 2001;345:1400-8.
[20] Gordon Y B, Lewis J D, Pendlebury D J, Leighton M. Assessment of
outcome in threatenedabortion. Lancet 2004; 1:1001-3.
[21] Stein Z, Kline J, Susser M. Induced abortion and the chromosomal
characteristics of subsequent miscarriages. Am J Epidemiol 1999;
123:1066-79.
[22] Rai R, Clifford K, Regan L. Early pregnancy bleeding and suboptimal
perinatal outcomes .Acta obstet Gynecol Scand 1999;10:35-9.
[23] Sipila P, Hartikainen-Sorri AL. Perinatal outcome of pregnancy
complicated by vaginal bleeding. Br J Obstet Gynaecol 2000;99:959-63.
[24] Freeman SA, Charles DR, Griffth SD. Factors underlying preterm
labour. Obstet Gynecol2001; 74:52-9.
[25] Hertz JB.Anderson KG. The outcome of pregnancy after threatened
abortion. Acta Obstet Gynecol Scand 1985; 6:151-6.
[26] Williams MA, Mittendorf R, Leiberman E, Monson RR. Adverse
outcomes of pregnancy associated with first trimester vaginal bleeding
.Obstet Gynecol 1991; 78:14-8.
[27] Jones WR, Chapman MG, Furness ET.Significance of the ultrasound
location of placental site in early pregnancy. Br J Obstet Gynaecol
.1979; 86:84-8.
[28] Haddow JE, Knight GJ, Kloza EM, Palomaki GE. Alpha fetoprotein ,
vaginal bleeding and pregnancy risk. Br J Obstet Gynaecol
.1986;93:589-93.
[29] Pedersen JF, Mantoni M. Fetal growth delay in threatened abortion : an
ultrasound study. Br J Obstet Gynaecol 1982 89;525: 9.
[30] Jandial WD, Malik GH. Factors responsible for early pregnancy
bleeding.Obstet Gynecol 1978;68:14-8.
[31] Whittaker M, Pedersen JF. Intrauterine haematoma : An ultrasonic study
of threatened abortion. Br J Obstet Gynaecol 1983;88:47-51.
[32] James G A, Field HJ. Prediction of outcome in pregnancies complicated
by bleeding Acta Obstet Gynecol Scand 1987; 49:89-5.
[33] Williams MA, Mittendorf R, Leiberman E, Monson RR. Adverse
outcomes of pregnancy associated with first trimester vaginal bleeding
.Obstet Gynecol 1996;78:14-8.
[34] Bromley B, Bennett GL, Lieberman E, Benacerraf BR. Subchorionic
hemorrhage in first-trimester. Lancet 1996;200:803-6.
[35] OrnoyA ,Benady S, Kohen-Raz R. Association between maternal
bleeding during gestation and congenital anomalies in the offspring. Am
J Obstet Gynecol 1976;124:474-8.
[36] Berkowitz GS, Harlap S, Beck GJ :Early gestational bleeding and
pregnancy outcome. Int JEpidemiol 1983;12:165-73.
[37] Arafa M, Abdel-Fataah M, Zeid HA, el-Khouly A. Outcomes of
pregnancies complicated by early vaginal bleeding. East Mediterr Health
J. 2000;6(2-3):457-64.
[38] Shapiro S, Abramowicz M. Pregnancy outcome correlates identified
through medical record based information. Am J Public Health
1969;59:1629-50.
[39] Holmes LB, Simpson JL, Mills JL. Low fetal loss rates after ultrasound
proved viability in early pregnancy. JAMA 1999; 258:2555,.
[40] Stevenson HD, Tapanainen J, HuhtaniemiI : Plasma hCG levels in
patients with bleeding in the first and second trimesters of pregnancy. Br
J Obstet Gynaecol 1950; 56: 82-9.
[41] Copper GH, Grace DF, Micheal KJ. Ultrasonography and bleeding in
early pregnancy.Am J Obstet Gynecol 1981;16:136-9 .
[42] Green DA, David SR, Robinson FR. Pregnancy outcome after bleeding
in early pregnancy. Acta Obstet Gynecol Scand 1990;64:151-64
[43] Nagy S, Bush M, Stone J, Lapinski RH, Gardo S. Clinical significance
of subchoronic and retroplacental hematomas detected in the first
trimester of pregnancy. Obstet Gynecol 2003;102:94-100.
@article{"International Journal of Medical, Medicine and Health Sciences:68514", author = "S. Chhabra and C. Tickoo and P. Kalra", title = "Perinatal Outcome in Cases with Bleeding during First and Early Second Trimester", abstract = "Background: Bleeding during first half of pregnancy
mostly originates from placenta, some abort, others are at risk of
complications. Objective: Study was done to know perinatal outcome
with bleeding up to 20 weeks in singleton pregnancy. Material
Methods: Subjects were 1020, equal controls managed over 2 years,
435 had viable pregnancy at admission, 135 excluded, 300 followed
for perinatal outcome, 99 (19.52% up to 10 weeks), 201 (39.18% of
11-20 weeks). Results: Hypertensive disorders occurred in 24% cases
of bleeding within 10 weeks, 22% 11-20 weeks 14.79% controls,
placenta previa 4% in 10 weeks, 0.9% 11-20 weeks, 0.97% controls,
prelabor rupture of membranes in 16%, 7.45% controls. 20% up to 10
weeks, 35% 11-20 weeks, 18% controls had fetal growth restriction,
34.34% up to 10 weeks 30.35% of 11-20 weeks 17.17% controls had
preterm births, perinatal mortality rate in study was 118.62, in
controls 68.16 (Uneventful pregnancy in 13.52% study, 46.11%
controls). Conclusion: Once bleeding occurs, one third continue
pregnancy, maternal neonatal outcome gets affected with variations
in cases of bleeding within first 10 weeks & 11-20 weeks.
", keywords = "First, Second trimester, bleeding, Disorders,
Perinatal Outcome.", volume = "8", number = "1", pages = "61-6", }
