Abstract
Bleeding in newborns and young girls fascinated writers for more than a millennium. Initially, there was confusion between neonatal bleeding, early menstruation due to precocious puberty, and hemorrhage due to disease. During the 19th century descriptions appeared of what is referred to today as ‘neonatal menstruation’ or ‘neonatal uterine bleeding’. By the turn of the century, Halban linked bleeding to active substances present during pregnancy and hypothesized that, while the maternal uterus reacts with decidua formation, the “weaker” fetal uterus reacts only with menstrual-like changes. Despite this clear description, several alternative theories endured for decades. Bleeding was believed to be due to a ‘catarrhal’ or neoplastic state of the genital tract, pulmonary circulatory disorder, congenital heart malformations, closure of the umbilical cord or affections of the intestine. During the 1950s, progesterone response and resistance were proposed to explain the pathogenesis of bleeding and its low incidence. The fetal endometrium is resistant to the high circulating progesterone. A decidual response is infrequent and results in menstrual shedding upon progesterone withdrawal after birth. Further research linked fetal stress consequent to pregnancy complications and post-maturity to increased incidence and preterm birth to reduced incidence of neonatal uterine bleeding.
Highlights
During the last part of the 20th century, the occurrence of a vaginal bleeding during the first days of post-natal life in some female neonates was considered a natural event caused by the rapid drop in circulating steroid hormones after birth
Interest in Neonatal Uterine Bleeding (NUB) was renewed following the publication of a brief article raising the possibility that NUB is involved in the pathogenesis of early-onset endometriosis [2]
At the outset, to point out that neonatal menstruation came to be recognized as a distinct entity during the first part of 19th century
Summary
Giuseppe Benagiano 1, Marwan Habiba 2,* , Donatella Lippi 3 and Ivo A.
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