Occurrence Of Vaginal Bleeding Research Articles

Evaluation of fetal and maternal outcomes in chorion villus sampling (CVS)

Background: Chorionic villus sampling (CVS) is one of the invasive diagnostic methods used to diagnose chromosomal, genetic, and metabolic diseases in the embryonic period. The use of this method is associated with maternal and fetal consequences, the most serious of which is abortion. Therefore, the present study was conducted to investigate the incidence of these consequences and the factors affecting the incidence of abortion.Materials and Methods: A cross-sectional study was performed on 98 pregnant women with CVS indications. Maternal and fetal outcomes including abortion, vaginal bleeding, subchorionic hematoma, premature rupture of membrane (PROM), chorioamnionitis, preterm delivery, limb abnormality, fetal growth retardation, and preeclampsia were recorded.Results: The results of the present study showed that the incidence of fetal outcomes including fetal growth failure, premature rupture of membranes, abortion, and limb abnormalities was 4.1%, 7.1%, 3.1%, and 1%, and the incidence of maternal outcomes including preterm delivery, subchorionic hematoma, preeclampsia, and hemorrhage was 14.3%, 3.1%, 6.1%, and 10.2%, respectively. In addition, a decrease in free BHCG and an increase in NT were significantly associated with the occurrence of abortion (OR: 0.11 and 4.25, respectively, P value < 0.05).Conclusion: It should be noted that due to a long time between placental sampling and the occurrence of vaginal bleeding, premature rupture of membrane, and preterm delivery, it seems that placental sampling has no effect. In addition, only a decrease in free BHCG or an increase in NT significantly increased the chance of miscarriage.

Pilot study of women’s perspectives when abnormal uterine bleeding occurs during perimenopause

Objective We gained insights into women’s experiences and knowledge about the occurrence of vaginal bleeding during perimenopause requiring evaluation. Methods Qualitative inquiry was chosen to explore topics in greater depth to understand individuals’ experiences. Interviews with individuals were chosen due to the sensitive nature of gynecologic symptoms and management. Interviews were completed following gynecologic care to explore individuals’ experiences with the evaluation and management of vaginal bleeding during perimenopause. Results Twelve individuals were interviewed between December 2019 and March 2020. Patient uncertainty about the medical significance of developing vaginal bleeding during perimenopause was associated with self-appraisal and gathering information from multiple sources. This experience of seeking evaluation and treatment resulted in varying degrees of trust concerning information received within or outside the clinic. Regarding new technologies that could replace the current invasive tests performed for diagnosis (i.e. ultrasound, hysteroscopy and biopsy), most women preferred the smartphone app and tampon home collection option. Conclusions The experience of irregular or heavy vaginal bleeding during perimenopause is fraught with ambiguity, feelings of uncertainty about how to make sense of symptoms and inevitably begins with a period of self-appraisal.

Hyperthyroid Manifestation in Beta HCG Secreting Tumor

Background: Serum β-Human Chorionic Gonadotropin (HCG) levels can be increased not only in pregnancy but also in various malignancies such as germ cell malignancy, lung cancer, ovarian cancer, and breast cancer. The alpha subunit of HCG and TSH are homologous, so β-HCG can cross-react with the TSH receptors and induce hyperthyroidism. High level of β-HCG serum can lead to hyperthyroidism, which can aggravate the patient’s malignant manifestations. Case Presentation: A 33-year old woman admitted to our hospital with chief complaint general weakness one week before admission. The patient was 8 week-pregnant and the transabdominal ultrasound showed a gestational sac and she had also a positive urine β-HCG test. The patient had slight vaginal bleeding 1 month ago. The physical examination revealed tachycardia, pale conjunctiva, and multiple nodules in both breasts. On laboratory examination, we found low level of Hb 6.7 (n 11.7 - 15.5 g/dl), serum iron 18 (n 65 - 175 mg/dL), TIBC 164 (n 253 - 435 mg/dL), and ferritin 1971(n 4.63-204 mg/dL), positive urine β-HCG, potassium 2.5 (n 3.1 - 5.1 mmol/L). On transvaginal and transabdominal ultrasound examination, there was no gestational sac in the uterine cavity and there are no abnormalities in other gynecology organs. The chest X-ray showed a nodule in the upper right lung suggestive of metastasis with thickening of the soft tissue of the left mammary region suggestive of a left breast mass. We also found a consistent positive result of urine β-HCG, though it had passed four weeks after the occurrence of vaginal bleeding. Finally, the serum β-HCG examination was carried out and showed an increased result, 290,398 (n <5 mIU/ml). The chest CT showed a heterogeny mass (mixed iso-dense and hypodense) that enhanced contrast on the inferior lobe of left lung (4.1 cm x 12.1 cm x 14.1 cm), a mass on apical segment of right lung, subpleural nodule, a mass on the right kidney, spleen, and mediastinal lymphadenopathy. The patient had packed red cell transfusion and after the Hb level reached 11 mg/dl, she still had tachycardia, so we examined the TSHs level. TSHs was found to be low at 0.014 (n 0.48-4.17 mg/dL), and FT4 increased to 2.82 (n 0.89-1.76 mg/dL). Thyroid ultrasound showed small simple cysts in both inferior thyroid pools, no solid mass and no increased vascular flow to the thyroid parenchyma. The patient was then thought to have hyperthyroid manifestation due to β-HCG secreting tumor. She was had methimazole and propranolol therapy, and a lung biopsy was planned. Conclusion: Trophoblastic and non-trophoblastic tumors that secrete high level of β-HCG can induce hyperthyroid manifestations, particularly if the level was more than 20,000 mIU/mL

Maternal coffee intake and the risk of bleeding in early pregnancy: a cross-sectional analysis

BackgroundCaffeine can easily cross the placenta, and maternal caffeine intake, thus, has an effect on fetal growth. However, it is still unclear whether coffee consumption is an independent risk factor for bleeding in early pregnancy. The objective of this study was to examine the association between pre-pregnancy coffee consumption patterns and the risk of bleeding in early pregnancy.MethodsA cross-sectional analysis was conducted among 3510 pregnant women from the Korean Pregnancy Outcome Study who underwent baseline examination and for whom the results of the pregnancy were available. Coffee consumption patterns before pregnancy were examined using a questionnaire. The participants were classified according to the frequency of coffee consumption into seldom (< 1 cup/week), light (< 1 cup/day), moderate (1 cup/day), and heavy coffee drinker (≥2 cups/day) groups. Bleeding in early pregnancy was defined as the occurrence of vaginal bleeding in the first 20 weeks of pregnancy. Multiple logistic regression models were applied to examine the association between pre-pregnancy coffee consumption and the risk of bleeding in early pregnancy, after adjusting for age, body mass index (BMI), systolic blood pressure, cigarette smoking and alcohol consumption behavior, previous and current physical activity levels, stress levels, history of depression, antenatal depressive symptoms during the first trimester, type of emesis, parity, and the number of livebirths, stillbirths, miscarriages, and abortions.ResultsWomen who were light, moderate, and heavy coffee drinkers before pregnancy had adjusted ORs of 1.086, 1.225, and 1.358, respectively, for bleeding in early pregnancy. In a fully adjusted model, heavy coffee drinkers showed a significantly higher risk of bleeding in early pregnancy, even in women aged 35 years and younger (OR 1.680) and in those with a normal body mass index (OR 1.389), who were at relatively low risk for pregnancy-related complications.ConclusionsOur results showed that heavy coffee drinking was independently associated with a higher risk of bleeding in early pregnancy among pregnant Korean women, suggesting that caffeine intake before conception and during pregnancy should be reduced. Our study highlights the need for nutritional interventions for healthy coffee drinking among pregnant women in Korea.

Long Term Outcomes Following Laparoscopic Supracervical Hysterectomy Performed with and without Excision of the Endocervix

To compare the occurrence of continued vaginal bleeding as well as patient satisfaction after laparoscopic supracervical hysterectomy performed with and without excision of the endocervix in a reverse cone pattern. Prospective randomised trial. Study patients were followed up 3 and 12 months after the operation at the outpatient clinic. Norwegian university teaching hospital. Premenopausal women who were referred to the department due to a benign condition requiring hysterectomy. 140 women planned for laparoscopic supracervical hysterectomy were enrolled in the study. They were operated in the period from November 2008 to October 2010. The study participants were randomized to laparoscopic supracervical hysterectomy performed with peroperative electrocoagulation of the upper cervical canal (n = 70) or performed by excision of the endocervix in a reverse cone pattern followed by electrocoagulation of the reminant cervical canal (n = 70). The intervention was blinded both for the patient and the doctor that examined the patients at the outpatient clinic. The main outcomes of the study were occurrence of vaginal bleeding and patient satisfaction 12 months after laparoscopic supracervical hysterectomy. The results of the study are ready in time for the AAGL Congress November 2011.

Severe physical violence among intimate partners: a risk factor for vaginal bleeding during gestation in less privileged women?

To evaluate the role of severe physical violence within intimate partners on the occurrence of vaginal bleeding during gestation in less privileged women. Health service survey. Three large public maternities in the city of Rio de Janeiro, Brazil. Five hundred and twenty-eight women who gave birth to full-term newborn infants were selected at random among the births that took place during the six months of fieldwork. Information on vaginal bleeding during gestation was obtained from medical records, pre-natal cards, and by means of a questionnaire addressed to the women giving birth. To collect severe physical violence data, use was made of the Portuguese version of the instrument Revised Conflict Tactics Scales, formally adapted for use in Brazil. Vaginal bleeding during gestation. After accounting for socio-economic, demographic, reproductive, and pregnant women's life-style variables, women who had been victims of two or more acts of severe physical violence were 2.74 (95% CI: 1.37-5.48) times more liable to present with vaginal bleeding during pregnancy than those who did not. Our findings suggest that physical violence increases the risk of vaginal bleeding in pregnancy. This result should encourage studies on whether intervention in violent relationships can reduce the risk of vaginal bleeding and other pregnancy complications.

Long-Term Outcomes Following Laparoscopic Supracervical Hysterectomy

It is unclear whether the risk of persistent vaginal bleeding and pelvic pain following surgery is increased following laparoscopic supracervical hysterectomy (LSH) compared to total laparoscopic hysterectomy (TLH). In Norwegian women who underwent LSH, this retrospective study evaluated the occurrence of vaginal bleeding and pelvic pain, the toleration of residual symptoms, and overall satisfaction with the procedure through the use of a postal questionnaire during 2004 and 2005. Of a total of 315 consecutive patients contacted 12 to 36 months after surgery, 240 (78%) responded. Menstrual bleeding continued in 24% (57 women) but was considered minimal in 90% of the women; on a 10-point visual analogue scale (VAS), the mean bothersome score was 1.1 (SD 2.0). When only regular bleeding was included in the analysis, the percentage decreased from 24% to 8%. Women with a less experienced surgeon were more likely to report continued vaginal bleeding (P < 0.02). Of the 178 women (74%) with menstrual pain before LSH, up to 3 years after surgery, 89 women (38%) reported continued menstrual/cyclical pain. However, the pain was considerably less intense; the mean VAS-10 score before and after surgery was 6.8 (SD 2.05) and 3.5 (SD 2.16), respectively (P < 0.01). Significantly higher levels of residual menstrual/cyclical pain after surgery occurred among women reporting endometriosis as a reason for the hysterectomy compared with women who did not (P < 0.001). A total of 90% of the women were very satisfied (70%) or satisfied (20%) with the hysterectomy. These findings show a high level of patient satisfaction with LSH despite the relatively common occurrence of residual menstrual bleeding and pain.

A prospective, randomized, controlled trial comparing vaginal misoprostol and osmotic dilator in achieving cervical ripening before operative hysteroscopy

The purpose of this study was to compare the effectiveness of vaginal misoprostol and an osmotic dilator in achieving cervical ripening before operative hysteroscopy in pre-menopausal women. One hundred patients undergoing operative hysteroscopies with a 9-mm hysteroscope were prospectively and randomly assigned to two groups. In group 1 (the misoprostol group), 53 patients received 400 μg of vaginal misoprostol 12 h before the operation. In group 2 (the osmotic dilator group), 47 patients had an osmotic dilator inserted into the cervical canal 12 h before the operation. The primary outcome measure in this study was cervical width, assessed by the largest number of Hegar dilators that could be inserted into the cervix without resistance. The secondary outcome measure was the subjective assessments of the ease of dilatation to 9 mm by the surgeon. Adverse effects experienced including preoperative pain and vaginal bleeding were recorded for each group. There was no difference between the two groups with regard to demographic variables. The spontaneous cervical dilatation (mean ± SD) in the osmotic dilator group (9.6±2.2 cm) was significantly (P<0.01) greater than that in the misoprostol group (8.0±1.8 cm). In addition, the proportion of difficult dilatation in the osmotic dilator group (8 out of 47, 17.0%) was significantly less than that in the misoprostol group (22 out of 53, 41.5%). The occurrence of vaginal bleeding in the misoprostol group (77.4%) was significantly (P<0.01) higher than that in the osmotic dilator group (31.9%). The osmotic dilator is more effective than misoprostol at achieving cervix ripening prior to operative hysteroscopy.

Predictors of vaginal bleeding during the first two trimesters of pregnancy

This study evaluates maternal age, race, cigarette smoking, prior spontaneous abortion, prior induced abortion, and prior preterm birth in relation to vaginal bleeding during the first two trimesters of pregnancy. Information on vaginal bleeding and predictors came from the Pregnancy, Infection, and Nutrition Study, which enrolled 2806 pregnant women at 24-29 weeks' gestation during 1995-2000 in central North Carolina, USA. Generalised estimating equations were applied to take into account repeated episodes of vaginal bleeding during pregnancy. Women with advanced maternal age and passive smoking exposure were more likely to experience more intense vaginal bleeding during pregnancy, as were women with prior preterm birth. More intense bleeding was also more likely to be reported among women with multiple prior spontaneous abortions or multiple prior induced abortions, but not among women with a single prior spontaneous or induced abortion. The combination of prior spontaneous and induced abortion showed a dose-response association with the occurrence of vaginal bleeding during pregnancy.

The role of ultrasound imaging in diagnosing and investigating early pregnancy failure

The advent of high-resolution transvaginal ultrasound (TVS) has revolutionized our understanding of the pathophysiology and the management of early pregnancy failure. Knowledge of the ultrasound appearances of normal early pregnancy development and a good understanding of its pitfalls are essential for the diagnosis and management of early pregnancy failure. Ultrasound imaging has rapidly replaced all other techniques used to study normal human development in the first trimester, and ultrasound features of the early gestational sac have corroborated anatomical studies showing that the first structures to appear are the celomic cavity and the secondary yolk sac. No single ultrasound measurement of the different anatomical features in the first trimester has been shown to have a high predictive value for determining early pregnancy outcome. Similarly, Doppler studies have failed to demonstrate abnormal blood flow indices in the first-trimester uteroplacental circulation of pregnancies that subsequently end in miscarriage. Ultrasound parameters combined with maternal serum hormone levels, maternal age, smoking habits, obstetric history and the occurrence of vaginal bleeding have all been combined in multivariate analyses, with mixed results. Combined ultrasound and in-vitro experiments have demonstrated that the maternal circulation inside the placenta starts at the periphery at around 9 weeks of gestation and that this is associated with a physiological oxidative stress which could be the trigger for the formation of the placental membranes. Abnormal development of these membranes can result in subchorionic hemorrhage and threatened miscarriage with subsequent long-term consequences such as preterm rupture of the membranes and preterm labor, irrespective of the finding of a hematoma on ultrasound. In both euploid and aneuploid missed miscarriages there is clear ultrasound evidence for excessive entry of maternal blood at a very early stage inside the developing placenta resulting in oxidative stress and subsequent degeneration of villous tissue. The finding of blood flow in the intervillous space in cases of first-trimester miscarriage using color Doppler also appears to be useful in the prediction of success of expectant management. Miscarriages with blood flow within the intervillous space are up to four times more likely to complete with expectant management. TVS is considered the gold standard in the diagnosis and management of incomplete miscarriage. Expectant management of miscarriage, using ultrasound parameters to determine eligibility, could significantly reduce the number of unnecessary evacuations of the retained products of conception, depending on the criteria used.

Bleeding patterns and endometrial histology during administration of low-dose estradiol sequentially combined with dydrogesterone

Objective To determine bleeding patterns and endometrial response in postmenopausal women taking low-dose (1 mg) estradiol in a sequential combined formulation with 5 or 10 mg dydrogesterone.Methods A total of 151 postmenopausal women were allocated randomly to 5 or 10 mg dydrogesterone during cycle days 15–28 in a sequential oral formulation with 1 mg estradiol continuously during 13 cycles of 28 days. Occurrence of vaginal bleeding was recorded daily and analyzed in accordance with World Health Organization (WHO) standards. Endometrial biopsies, obtained at baseline and cycle days 25–27 of the final treatment cycle, were interpreted independently by two pathologists.Results The study was completed by 131 women (87%). The percentage of women with bleeding (mean±SD) was 57.2±3.6% in the 1/5-mg group and 65.8 ±4.2% in the 1/10-mg group (p < 0.001); cross-sectional analysis showed that, in every cycle, there were more women with bleeding in the 1/10- than in the 1/5-mg group (p < 0.001). With regard to the day of onset of bleeding, the mean difference between groups was 1.4 ± 1.1 days (p < 0.001). There was no difference in duration of bleed (5 days), or intensity or incidence of intermittent bleeding (3–14% per cycle). Both regimens resulted in high rates of amenorrhea in each cycle (26–49%), but only 14/151 (9%) women were amenorrheic throughout. Three patients (2%) discontinued owing to bleeding problems. Endometrial protection was adequate in 98.3% (1/5-mg group) and 98.5% (1/10-mg group) with only one case of proliferation (1/10-mg group) and one of simple hyperplasia (1/5-mg group).Conclusions The bleeding pattern associated with low-dose (1 mg) estradiol sequentially combined with 5 or 10 mg dydrogesterone shows a high rate of amenorrhea in each cycle; there is a dydrogesterone dose effect on the occurrence and day of onset of bleeding. Bleeding episodes that occur show a regular pattern and are of slight intensity. The endometrial safety of both regimens is high.

Cause of vaginal bleeding in postmenopausal women taking tibolone.

To determine the cause of vaginal bleeding in postmenopausal women treated with tibolone. Forty seven consecutive unselected women who bled in the course of treatment with tibolone between 1986 and 1995. Clinical evaluation and pelvic ultrasound scanning in all women and additional Doppler flow assessment in 12. Hysteroscopy was performed in 20 women and D and C in nine. An endometrial polyp was found responsible for the bleeding in 11 women and uterine fibroids in seven. Thickened endometrium was seen on ultrasound in six women; there was no histological abnormality in three of these women, two had benign simple hyperplasia and the remaining woman had an early carcinoma in situ. Carcinoma in situ was also found in another woman as an incidental finding in the endometrial curettings taken at hysteroscopy in the course of polypectomy. In over half, however, (24 women), no intrauterine cause could be found to account for vaginal bleeding. The occurrence of vaginal bleeding after tibolone clustered in two groups; 30 women who bled within 4 months of starting tibolone (of whom 17 had recently taken oestrogens) and 17 who bled after at least a years' therapy. Bleeding after tibolone requires investigation. A morphological abnormality may be present even in women who have recently taken oestrogens and experienced cyclical bleeding. Despite full investigation, no cause for bleeding was however found in over half the group. The majority (37 women) of those who reported bleeding nevertheless continued on tibolone after completion of investigations with no recurrence of bleeding.

Vaginal bleeding and early pregnancy outcome in an infertile population.

Our purpose was to determine the prognostic value of vaginal bleeding in early pregnancy outcome as well as to analyze the role of cardiac activity in predicting pregnancy viability in the presence of vaginal bleeding. This was a cohort study of pregnancies obtained using either assisted reproductive technology (ART) or routine infertility treatment (RIT). Two hundred twenty-eight pregnant women were divided into two groups based on the presence or absence of vaginal bleeding. Successive measurements of beta-hCG levels were obtained every 2 days, starting on day 14 after ovulation or embryo transfer. All pregnancies underwent weekly transvaginal ultrasound (UTZ) examinations beginning on day 21. The occurrence of vaginal bleeding was monitored weekly. Seventy of the 228 patients (31%) had bleeding in early pregnancy, resulting in 31 (44%) pregnancy losses. Only 22 pregnancy losses (14%) were observed in 158 patients who did not have bleeding (P < 0.001). The abortion rate for the bleeding versus nonbleeding groups was 35 and 9%, respectively (P < 0.001). Vaginal bleeding was associated with a higher abortion rate in pregnancies following RIT than ART (51 vs 8%; P < 0.001). Fetal cardiac activity was noted by vaginal ultrasound in 189 patients. In this subpopulation, bleeding was also associated with a higher abortion rate than that in the nonbleeding group (17 vs 4%; P < 0.001). However this higher incidence was observed only in pregnancies following RIT, not ART (28 vs 5%; P < 0.001). Although bleeding significantly decreased the chance of a normal pregnancy outcome, more than 50% of the pregnancies did progress to term. The presence of cardiac activity in this population as a sign of fetal viability offered a better pregnancy prognosis. However, the predictive value of fetal cardiac activity was reduced in the presence of vaginal bleeding in an infertile population treated with RIT.

Breast-feeding and return to fertility: Clinical evidence from Pakistan, Philippines and Thailand

The author reports on studies of the relationship between breast-feeding and fertility in Pakistan, the Philippines, and Thailand. "The accumulated evidence suggests that during the first six months of unsupplemented breast-feeding, if the mother remains amenorrheic, then the breast-feeding stimulus is usually sufficient to postpone the recovery of fertility. Breast-feeding frequency alone is not a useful measure of the breast-feeding stimulus in terms of its ability to predict the return of menses or ovulation."

Hemorrhagic necrosis of the senile endometrium ("apoplexia uteri"). Relation to superficial hemorrhagic necrosis of the bowel.

Abstract The uteri of 379 women over 50 years of age were studied at autopsy; endometrial hemorrhage, with or without necrosis, was found in 19. These postmenopausal patients had no evidence of hormonal abnormalities that could have given rise to a situation analogous to menstruation. Every patient experienced varying degrees of cardiovascular decompensation for variable periods before death; a background of organic or functional cardiac disease was uniformly present. Hemorrhagic enteropathy was noted in six (31.6 per cent) of the subjects displaying the endometrial lesion. The common morphologic features and clinical backgrounds of these entities suggest a similar pathogenetic mechanism: inadequate perfusion of the areas in question appears most likely. The occurrence of vaginal bleeding in an elderly female in shock should suggest endometrial ischemia as a possible cause, and it may serve to warn of the development of hemorrhagic necrosis of the bowel.

Diagnosis of Placenta Praevia by Photoscanning With Albumin Labeled With Technetium Tc 99m

The occurrence of vaginal bleeding during the third trimester of pregnancy presents a challenging problem in obstetrical diagnosis and management. If placenta praevia is the cause of bleeding, close medical observation is necessary and the majority of patients will be delivered by cesarean section prior to term. If placenta praevia is present, vaginal examination may cause sufficient hemorrhage that immediate delivery of the infant is necessary. A method for the accurate diagnosis of placenta praevia, without vaginal examination, when vaginal bleeding first occurs, therefore would be of great importance. Procedures to estimate the size and position of the placenta such as soft-tissue radiography, injection of radiopaque dye into the vascular bed of the placenta, or surface counting of the trace amounts of radioisotopes (usually iodinated I 131 serum albumin or sodium chromate Cr 51-tagged red blood cells) in the placental blood pool are clinically useful. Too often, however, these procedures