Trimester Bleeding Research Articles

MATERNAL AND PERINATAL OUTCOMES OF EARLY TRIMESTER BLEEDING

Bleeding per vagina is one of the most everyday presentations in the first trimester, with an incidence of 15- 25%. These pregnancies end up in pregnancy loss and multiple poor feto-maternal outcomes requiring early registration and treatment. Objectives: To evaluate for maternal perinatal outcomes in normal intrauterine pregnancies complicated by first-trimester vaginal bleeding Methods: This cohort study was conducted at the Gynecology and Obstetrics department of Lady Reading Hospital Peshawar from January 2024 till the required sample size is obtained in May 2024. Data were collected from 195 pregnant females. Women were divided into two groups. All pregnant women with singleton pregnancy and with or without vaginal bleeding during the first trimester, defined as up to the first 12 weeks of pregnancy, both delivering at our institute, were selected. Results: Miscarriage rates were notably higher in the exposed group (20.4% vs. 10.3%, OR 3.5, p=0.02), as were preterm births (22.4% vs. 15.5%, OR 2.8, p=0.01) and placental complications (12.2% vs. 5.2%, OR 4.2, p=0.03). The exposed group also had higher rates of postpartum hemorrhage (14.3% vs. 10.3%, OR 2.2, p=0.01), though cesarean section rates were similar between groups (30.6% vs. 30.9%, OR 2.0, p=0.15). Conclusion: It is concluded that early trimester bleeding is associated with an increased risk of adverse maternal and perinatal outcomes, including miscarriage, preterm birth, placental complications, and low birth weight.

Pregnancy out come in first trimester bleeding

Pregnancy out come in first trimester bleeding

Simulation training improves resident physicians’ confidence in managing first trimester bleeding in the emergency department

First trimester bleeding is commonly encountered in pregnancy and can be potentially life-threatening. Simulation training provides an ideal opportunity for resident medical learners to improve clinical knowledge and gain confidence in managing life-threatening causes of first trimester bleeding in a realistic but safe clinical environment. The objective of this study was to assess the effectiveness of simulation in improving family medicine residents’ confidence and knowledge in identifying and managing first trimester bleeding in the emergency department (ED). The intervention was a two-hour educational simulation focusing on management of unstable first trimester bleeding. Twenty-one family medicine residents (67% female) at the University of Toronto participated in the simulation and completed pre- and post-simulation questionnaires assessing their confidence and knowledge in management of first trimester bleeding. This study demonstrates that simulation training improves resident physicians’ confidence in managing first trimester bleeding in the ED. Additionally, it improves their objective history taking skills. Post-graduate medical programs should consider developing structured simulation, particularly for high-yield clinical cases residents may not otherwise have acute exposure to and are required to be competent in managing.

P-782 Are pregnancy complications associated with the method of conception in female same-sex couples? Results of a retrospective, matched cohort study comparing ROPA and IUI

Abstract Study question Are pregnancies in female same-sex couples at a higher risk when using reception of oocytes from partner (ROPA) compared to those following intrauterine insemination (IUI)? Summary answer In female same-sex couples, pregnancies following ROPA demonstrated a higher incidence of preterm birth and first-trimester bleeding. What is known already Reception of Oocytes from PArtner (ROPA) enables both partners to contribute biologically to the desired pregnancy. However, oocyte donation, often performed in case of (premature) ovarian failure, is associated with an increased risk of hypertensive disorders of pregnancy/preeclampsia. Female same-sex couples typically comprising healthy, young women without underlying subfertility problems, are a priori at low absolute risk for pregnancy complications. Few studies have investigated the incidence of pregnancy complications and/or obstetrical outcomes in this specific group of women. Further insights and formal data could guide clinicians and patients in making informed decisions regarding the preferred method of conception. Study design, size, duration A retrospective, single-center, matched cohort study was performed including 577 unique female same-sex couples using donor semen who became pregnant after reproductive treatment (88 pregnancies following ROPA and 489 following IUI). None of the patients who opted for ROPA had (failed) IUI before. The study covered the period from January 2015 to January 2023. Participants/materials, setting, methods Pregnancies following ROPA were matched with pregnancies following IUI for age (+/-4 years), BMI (+/-4 kg/m2), parity (nulliparous vs multiparous) and date of embryo transfer/IUI (+/-1year) in a 1:1 ratio. Statistical Package for Social Sciences (SPSS) v26.0 was used for statistical analysis. Kolmogorov-Smirnov test was used to evaluate the normal distribution of continuous variables. Normally distributed data were analyzed with the student t-test and categorical variables were analyzed with the chi-square test. Main results and the role of chance After matching, 154 pregnancies (77 ROPA versus 77 IUI) were eligible for the study. Age (mean age 31.4±4.0 for ROPA versus 31.2±4.3 years for IUI, p = 0.48) and BMI (24.5±3.9 kg/m2 versus 25.2±4.4 kg/m2, for respectively ROPA versus IUI, p = 0.32) were comparable between groups after matching. Two ROPA pregnancies were excluded from further analysis due to elective termination of pregnancy (radiusaplasia and trisomy 21). Both groups experienced two stillbirths (two unexplained mors in utero, one chorioamnionitis and one intrapartum death). No significant difference in hypertensive disorders of pregnancy (HDP) (10.7% (8/75) versus 13.7% (10/73) for ROPA and IUI respectively, p = 0.53) or preeclampsia rates (11.0% (8/73) and 6.7% (5/75) for ROPA and IUI respectively, p = 0.33) was observed. ROPA-associated preeclampsia cases were often preterm (<37weeks’ gestation) compared to IUI (5/8 versus 1/5). ROPA pregnancies had a higher incidence of preterm birth (15.1% vs 1.3%,p<0.002) and first trimester bleeding was significantly more frequent (12.3% vs 0%,p<0.001). No statistically significant differences were observed between groups in neonatal weight, fetal structural malformations and cesarean section delivery rates. Limitations, reasons for caution The study is limited by its retrospective design and inherent bias. Despite reducing the sample size, matching enhanced study robustness. Recognized risk factors for hypertensive disorder of pregnancy, like the use of donor sperm, may mitigate differences associated with conception methods in this population. Wider implications of the findings The study points out potentially increased obstetrical risks following ROPA. These data are crucial to counsel and guide female same-sex couples in their decision regarding the method of conception. The risk of hypertensive disorders of pregnancy, specifically preterm preeclampsia, associated with ROPA warrants further attention, urging larger prospective studies. Trial registration number not applicable

Natural proliferative phase frozen embryo transfer-a new approach which may facilitate scheduling without hindering pregnancy outcomes.

How does a natural proliferative phase (NPP) strategy for frozen embryo transfer (FET) compare with the conventional artificial (AC) and natural (NC) endometrial preparation protocols in terms of live birth rates (LBR)? This study supports the hypothesis that, just as for NC, NPP-FET may be a superior alternative to AC in terms of LBR. Although FETs are increasing worldwide, the optimal FET protocol is still largely controversial. Despite recent evidence supporting a possibly higher efficacy and safety of NC FETs, their widespread use is limited by the difficulties encountered during cycle monitoring and scheduling. In this single center retrospective cohort study, we describe the NPP-FET protocol, in which vaginal progesterone is initiated during the proliferative phase as soon as an endometrium with a thickness of at least 7 mm is identified and ovulation is ruled out, regardless of mean diameter of the dominant follicle. For comparison, we considered all blastocyst stage FET cycles preformed at a private infertility center between January 2010 and June 2022, subdivided according to the following subgroups of endometrial preparation: AC, NPP, and NC. We performed multivariable generalized estimating equations regression analysis to account for the following potential confounding variables: oocyte age at retrieval, oocyte source (autologous without preimplantation genetic testing for aneuploidies (PGT-A) versus autologous with PGT-A versus donated), number of oocytes retrieved/donated, embryo developmental stage (Day 5 versus Day 6), number of embryos transferred, quality of the best embryo transferred, and year of treatment. The main outcome measure was LBR. The secondary outcomes included hCG positive, clinical pregnancy and miscarriage rates, and the following perinatal outcomes: first trimester bleeding, second/third trimester bleeding, preterm rupture of membranes, gestational diabetes, gestational hypertensive disorders (GHD), and gestational age at delivery. A total of 5791 FET cycles were included in this analysis (2226 AC, 349 NPP, and 3216 NC). The LBR for FET was lower in the AC subgroup when compared to the NPP and NC (38.4%, 49.1%, and 45.2%, respectively; P < 0.01 AC versus NPP and AC versus NC). The rates of miscarriage were also lower in the NPP and NC subgroups when compared to AC (19.7%, 25.0%, and 34.9%, respectively; P < 0.01 NPP versus AC and NC versus AC). Considering perinatal outcomes, NPP-FET and NC were associated with a significantly lower first trimester bleeding compared to AC (17.3%, 14.7%, and 37.6%, respectively; P < 0.01 NPP versus AC and NC versus AC). Additionally, NC was associated with a lower rate of GHD when compared with AC (8.6% versus 14.5%, P < 0.01), while the rate following NPP-FET was 9.4%. This study is limited by its retrospective design. Moreover, there was also a low number of patients in the NPP subgroup, which may have led the study to be underpowered to detect clinically relevant differences between the subgroups. Our study posits that the NPP-FET protocol may be an effective and safe alternative to both NC and AC, while still allowing for enhanced practicality in patient follow-up and FET scheduling. Further investigation on NPP-FET is warranted, with prospective studies including a larger and more homogeneous subsets of patients. This research was supported by the IVI-RMA-Lisbon (2008-LIS-053-CG). The authors did not receive any funding for this study. The authors have no competing interests. Not applicable.

Analysis of First Trimester Bleeding - A Prospective Observational Study in Indian Population

Analysis of First Trimester Bleeding - A Prospective Observational Study in Indian Population

A Literature Review: Determinants Factors Associated with Maternity Emergency of Premature Rupture Membranes

Background: Premature Rupture of Membranes (PROM) is an emergency during to the puerperium which cause serious problems for the mother and fetus. Objective: To identify the determinants factors associated with PROM in pregnant women. Methods: A systematic review of the literature on articles published in the 2017-2022 timeframe. The journal was obtained through 8 databases (Google scholar, PubMed, Garuda Portal, Science Direct, Proquest, Crossref, National Library, Scopus) using "Maternity Emergency" AND "Premature rupture of membranes". Results: The results of the study search found 1,413 articles which seven articles were selected and reviewed. The results show that the factors associated with PROM included parity (p=0.034; 0.034; 0.001), maternal age (p=0.018; 0.018; 0.063), exposure to cigarette smoke (p=0.044), sexual pattern (p=0.008), frequency of ANC (p=0.001), anemia (p=0.001), history of cervical conization (p=0.010), cervical length &lt;25 mm at week 28 (p=0.009), negative lactobacillus (p=0.030), and second trimester bleeding (p=0.020). Conclusion: The most dominant factor associated with the incidence of PROM were history of cervical conization.

P-653 Natural proliferative phase frozen embryo transfers: a novel, safe and efficient transfer strategy

Abstract Study question How do natural proliferative phase for frozen embryo transfers (NPP-FET) compare to traditional artificial and natural cycle FETs in terms of pregnancy and neonatal outcomes? Summary answer NPP-FETs were associated with similar ongoing pregnancy rates after 22 weeks, but with less miscarriage rates comparing to artificial cycles. What is known already The best FET protocol for endometrial preparation is still controversial. A natural cycle (NC) FET may require more visits to the clinic and provides less flexibility. Conversely, artificial cycles (AC), although being more flexible in terms of scheduling, have been previously associated with higher rates of miscarriage and maternal morbidity. Here we describe an alternative FET strategy (NPP-FET) in which, during an unmediated ovulatory cycle, progesterone is initiated as soon as the endometrium proliferation reaches 7 mm of thickness, regardless of the size of the dominant follicle and without the administration of exogenous hCG or spontaneous LH peak. Study design, size, duration We performed a single center retrospective cohort study of FET cycles performed between January 2020 and June 2022 (n = 2158). Only single embryo blastocyst stage transfers were included. The main outcome was ongoing pregnancy rate after 22 weeks. Secondary outcomes included the number of visits to the clinic during monitoring, serum levels of progesterone on the day of FET, livebirth (LBR) and miscarriage rates, and maternal/perinatal outcomes. Participants/materials, setting, methods FETs cycles were divided in three subgroups: NC, NPP and AC. For the main outcome measures, a multivariable logistic regression was performed, to adjust for potential confounding (oocyte age/source, use of PGT-A and embryo quality), followed by pairwise comparisons whenever statistically significant. Main results and the role of chance In total, 2158 FET cycles were analysed (1219 NC, 277 NPP and 662 AC). The mean number of visits before FET planning were 2.14, 1.83 and 1.33 for NC, NPP and AC FETs, respectively (p &amp;lt; 001 for all pairwise comparisons). Mean progesterone levels on the day of transfer were significantly higher after NPP and NC (29.4 ng/mL and 40.2ng/mL, respectively), compared to AC (12.7 ng/mL). Progesterone rescue therapy (administered whenever serum progesterone &amp;lt;8.8 ng/mL) was also significantly more frequently needed following AC (24,9% for AC versus 0.6% and 2.6% in NC and NPP, respectively). The ongoing pregnancy rates after 22 weeks were 57.3% for NC, 55.6% for NPP and 54.5% for AC. LBRs following NPP were comparable with NC (38.9% and 42.7%, respectively), and significantly lower with AC (36.0%) compared to NC. The miscarriage rates were significantly lower after NPP and NC-FET when compared to AC (18.4%, 24.3% and 30.7% respectively). Considering maternal outcomes, NPP and NC were associated with a significantly lower risk of first trimester bleeding compared to AC (17.5%, 13.8% and 36.7%, respectively). The rate of gestational hypertensive disorders did not vary significantly (7.5% for NPP, 9.9% for NC and 12.6% for AC). Limitations, reasons for caution While serum progesterone and miscarriage rates comparable to NC-FET allude to the possibility that ovulation may still occur in NPP-FETs, this study cannot establish such causality due to its retrospective design. Moreover, the study may have been underpowered to detect clinically relevant subgroup differences such as for hypertensive disorders. Wider implications of the findings NPP-FETs seems to be an effective and safe alternative, potentially wielding both the advantages of the natural proliferative endometrium of the NC with the ease for scheduling of ACs. Nonetheless, further investigation is warranted attempting also to confirm whether ovulation does indeed still occur despite the progesterone administration. Trial registration number not applicable

Pregnancy Outcome in First Trimester Bleed

Background: There is disagreement on the outcome of vaginal bleeding during the first trimester. The purpose of this study was to ascertain the perinatal and maternal outcome for patients who presenting with vaginal bleeding during the first trimester. Methods: Over the course of a year, 1007 women with vaginal bleeding in the first trimester were included in this prospective observational study at a tertiary care hospital in Peshawar. The diagnosis was confirmed by a USG and a thorough history. All of these patients had their outcomes assessed, including spontaneous, threatened abortions, incomplete, and complete abortions, subchorionic hematoma, intrauterine foetal death, missed abortions, bleeding in the second and third trimesters, pre-mature rupture of membranes, intra-uterine growth restriction, and preterm births. Results: 1007 individuals with 11835 confinements had vaginal bleeding in first trimester. The age range of 21 to 30 years saw the highest occurrence (52.3%). First trimester haemorrhage was detected in 63.9 percent of primigravidas compared to 36.1 percent of multigravidas. It was shown that only 7% of patients who attended after 10 weeks had an abortion, compared to 76.9% of patients who presented before 6 weeks. In the 163 patients who continued to be pregnant after experiencing vaginal bleeding in first trimester, 1.8 percent had an abortion in the 2nd trimester, and 15.3% experienced premature labour. 6.75 percent of pregnancies end prematurely, and 1.8% experience antepartum haemorrhage. Conclusions: First trimester vaginal bleeding foretells ancillary maternal and foetal difficulties, according to the findings of the current study. Additionally, as clinical intervention plays a crucial part in preserving pregnancy and lowering foetal problems, careful supervision and planning by the doctor are crucial. Keywords: First trimester bleeding, Abortions, Threatened abortion, Preterm Labor,

Evaluation of the Efficacy of Ultrasound-Guided Interventions in Managing First-Trimester Vaginal Bleeding

Objective: Aim was to evaluate the efficacy of ultrasound-guided interventions in managing first-trimester vaginal bleeding. Study Design: Observational study Place and Duration: Gynaecology and Obstetrics Department people university of Medical and health sciences jamshoro Hyderabad. January 2022-December 2022 Methods: Total 116 pregnant females of first trimester were presented in this study. All the presented women had complaint of vaginal bleeding. Included patients had gestational age between 6-12 weeks. After a thorough clinical evaluation and diagnosis, patients were sent for an ultrasound. Ultrasound results were evaluated in terms of pregnancy type and types of abortions. SPSS 23.0 was used to analyze all data. Results: There were majority primi-gravida women 72 (62.1%) and 44 (37.9%) females were multigravida. Females mean age 27.5±12.19 years and had mean BMI 27.8±4.23 kg/m2. Mean gestational age of the females was 10.2±4.17 weeks. Frequency of viable patients was 36 (31.03%) and non-viable patients was 80 (68.97%). Among 80 non-viable cases, different type of abortions was found in 62 (67.5%) cases, ectopic pregnancy in 10 (12.5%) cases and molar pregnancy in 8 (10%) cases. Conclusion: Ultrasonography is the most accurate and non-invasive diagnostic method for distinguishing between the various conditions and phases of first trimester bleeding in pregnant women. The use of ultrasonography for prenatal screening has opened up new avenues for the timely treatment of patients, which has been shown to minimize death rates associated with pregnancy complications. Keywords: Abortion, First Trimester, Molar pregnancy, Ectopic Pregnancy

ROLE OF TRANSVAGINAL SONOGRAPHY IN FIRST TRIMESTER BLEEDING: A CROSS SECTIONAL STUDY

Introduction: First trimester bleeding has several causes such as Incomplete miscarriage, Hydatiform mole, subchorionic hemorrhage, embryonic mortality, anembryonic pregnancy, failed intrauterine pregnancy, total miscarriage, and ectopic pregnancy. Transvaginal and trans abdominal techniques are used to examine rst-trimester hemorrhage, transvaginal being preferred &amp; better method. To evaluate Aims and objectives: various causes of rst trimester bleeding and role of TVS in rst trimester bleeding. This cross-sectional study was Material And Methods: conducted on 50 patients in the Department of Radiodiagnosis at Rajshree Medical Research Institute, Bareilly, Uttar Pradesh from1st February 2021 to 31st July 2022. Majority of participants were aged 19–25yrs (56.0%).USG Diagnosis showed Results: Threatened abortion among 36.0%,Incomplete abortion among 22.0%, Complete abortion among 12.0%, Missed abortion among 8.0%,Ectopic gestation among 8.0%, Inevitable abortion among 6.0%,Anembryonic gestation among 4.0% and Hydatidiform mole among 4.0%.There was complete concordance between USG and Final Diagnosis.

EFFECT OF SUBCHORIONIC HAEMATOMA ON PREGNANCY OUTCOME: A RETROSPECTIVE STUDY

Objective: This study aims at comparative analysis of outcome of pregnancy in patients with 1st trimester bleeding ,with &amp; without sub-chorionic haemorrhage (SCH). Material and Methods: Pregnant women with vaginal bleeding upto14 wks. Study period was Jan 2020 - Dec 2021. Presence&amp; absence of SCH formed the study &amp; the control group respectively. Results: Both groups had similar demographic patterns &amp; parameters (parity, previous miscarriages &amp; gestational age at rst miscarriage). 15 out of 50 pregnancies (30%) with subchorionic Hematoma resulted in miscarriage, whereas it was 28 out of 210 pregnancies (13%) withoutsubchorionic hematoma. No signicant difference was found on the gestational age at miscarriage &amp; duration between 1st vaginal bleeding &amp; miscarriage.The outcome measures were also similar in both groups. Conclusion: Presence of subchorionic hematoma up to 14 wks. Of gestation increases risk of miscarriage, but pregnancy outcome in ongoing pregnancy is not altered.

First Trimester Bleeding in Pregnancy within the Gynecology and Obstetrics Department of Sourô Sanou Teaching Hospital in BoboDioulasso: 422 Cases Studied and Literature Review

Objectives: Study the epidemiological, clinical, therapeutic and prognostic aspects of the first trimester bleeding of pregnancy. Methodology: This was a descriptive cross-sectional study conducted within the Gynecology and Obstetrics Department of Sourô Sanou Teaching Hospital from January 1st to December 31st, 2019. The study included any patients admitted and treated for endo uterine bleeding in pregnancy with a term inferior or equal to 15 weeks of amenorrhea. The parameters studied were the following: sociodemographic characteristics (age, parity, level of education, occupation, marital status, origin), clinical and paraclinical aspects, diagnosis retained, treatment, and maternal prognosis. Information was collected from a survey form, from clinical records, operating protocols and anatomopathological reports. Data entry and analysis was made through Word and Epi-info 7.2.3 software. Results: During the period of study, 422 cases of first trimester bleeding were reported, corresponding to a frequency of 10.33%. The average age was 29 ± 6.4 years [15-49 years] and the average parity was 1.95 ± 1.7 [0-11]. Married women accounted for 75% of the population. The average gestational age was 9.14 weeks of amenorrhea [5-14 weeks of amenorrhea]. Clinical signs were dominated by vulvar bleeding in 100% of cases and pelvic pains in 86% of cases. All our patients had gone through pelvic ultrasound. As for the diagnoses retained, these included: a threatened abortion in 11.84% of cases, an incomplete abortion (46.77% of cases), an ectopic pregnancy (EP) (26.8% of cases), a terminated pregnancy (17.9% the cases) and a molar pregnancy (8.3% of cases).Abortions were managed through MVA (68.27%) and medical abortion (4.8%). All the cases of EP were treated surgically and no maternal deaths were recorded in our study. Conclusion: First trimester bleeding in pregnancy is common within the department. The main etiologies are threatened abortion, incomplete abortion, molar pregnancy and ectopic pregnancy.

A Study on Pregnancy Outcomes in Patients with First Trimester Vaginal Bleeding

Bleeding in first trimester of pregnancy poses a risk to embryo. It can be a natural symptom of implantation, sign of spontaneous abortion, or of pathologic condition like ectopic pregnancy/ gestational trophoblastic illness.4 Aim: To assess the etiology and outcome of first trimester bleeding. Objectives: (1) To study the etiology for first trimester bleeding. (2) To study the incidence of various etiological factors. Settings and design: This is the prospective observational study carried out in a tertiary health care centre over 2 years from October 2019 to october 2021. Materials and methods: This study was conducted on women with complaints of vaginal bleeding in first trimester of pregnancy. The methodology were explained to the women and valid informed written consent was recorded. The ethical clearance was obtained from ethical review committee of the tertiary care centre. After taking a detailed history and physical examination, the patient will undergo a urine pregnancy test, on confirmation she will be sent for a TVS scan depending upon the USG report further management and follow-up will be decided. Conclusion: Bleeding in first trimester doesn’t necessarily lead to miscarriage, but causes anxiety to the patient. Women and obstetricians should consider the outcome of continued pregnancies after the first trimester bleeding when planning antenatal care and clinical interventions. We need more researches on this to improve our better understanding and knowledge so that we can better plan the continued pregnancy as well as council the patient in better way.

Sonographic Findings in Patients with First Trimester Vaginal Bleeding in Aminu Kano Teaching Hospital

Background: Vaginal bleeding in early pregnancy is a common presentation in acute gyneacological settings. Ultrasonography is a popular and faster option for evaluating patients with these conditions. This is because it is a readily available, safe, and non-invasive imaging method for evaluating pregnancies, especially in the first trimester.&#x0D; Objective: To assess thesonographic findings in pregnant patients with first-trimester vaginal bleeding.&#x0D; Method: This was a cross-sectional descriptive study from patient’s record that was presented to the radiology department for a pelvic ultrasound on account of vaginal bleeding in their first trimester pregnancies for the year 2020. A prepared data collection sheet was used to document the sonographic findings for further analysis. Data were analyzed using SPSS version 16 and the results were presented in tables.&#x0D; Results: A total of 120 pregnant patients were recruited, with their ages ranging from 17- 47 years. The mean age was 29.59± 6.68 years. Threatened abortion was the common finding (32.5%), followed by complete abortion (30.8%), incomplete abortion (24.2%), missed abortion (5%), and ectopic pregnancy (3.3%). Anembyonic pregnancy had (2%) while inevitable abortion and molar gestation had (1.7%) each.&#x0D; Conclusion: Ultrasonography has proven to be a reliable diagnostic tool for patients with the first trimester bleeding Threatened and incomplete abortion were the common sonographic findings. Patients presenting with this clinical indication stand a chance to enjoy the timely results from ultrasound which will facilitate physicians' decision on the next ideal management for better outcomes.

Contribution of Ultrasonography in the Etiological Diagnosis of First Trimester Bleeding at the Nianankoro Fomba Hospital of Segou, Mali

Bleeding in early pregnancy is common. Approximately 20-25% of pregnant women may experience bleeding in early pregnancy. Half of the women who experience vaginal bleeding in the first trimester of pregnancy will carry their pregnancy to term. About 50% of first trimester bleeding will result in miscarriage. Given these factors, we evaluated the role of ultrasonography in the diagnosis of the first trimester bleeding. This prospective observational study took place from January 1 to December 31, 2019 at the ultrasonography unit of the Nianakoro Fomba Hospital of Segou. It involved pregnant women with first trimester bleeding who met the inclusion criteria of our study. Data were collected using a form and analyzed using EPIINFO version 7 software. The mean ± standard deviation of the age of the pregnant women was 26 ± 3.9 years with an age range of 15 to 43 years. On ultrasonography, out of 103 cases, 52.43% were abortions, 35.92% as threatened abortion and 8.74% as ectopic pregnancy. Ovarian detachment (29.13%) and interrupted pregnancy (22.33%) were the predominant ultrasonographic abnormalities. Ultrasonography remains an essential exam in the etiological diagnosis of first trimester bleeding.

S977 Ectopic Pregnancy in Women With IBD: Experience at a Tertiary Care IBD Center

Introduction: Women with IBD often have risk factors for ectopic pregnancy (EP) including previous abdominal or pelvic surgery, pelvic sepsis or intra-abdominal adhesions. The prevalence of an ectopic pregnancy among healthy women who present to an emergency department with first trimester bleeding, pain, or both ranges from 6% to 16%. To date, the single large population-based cohort study for EP in IBD was not able to account for medication use, disease activity or severity, and was published prior to wide-spread use of anti-TNF agents in the preconception and pregnancy states. We were interested in assessing EP in our population from a tertiary care IBD center, in particular taking into account disease activity and use of biologics prior to conception. Methods: The electronic medical record was queried for legal sex females with a diagnosis of ulcerative colitis (UC), Crohn's disease (CD) or inflammatory bowel disease (IBD) and a history of a pregnancy event receiving all of their care at our tertiary care center. From this cohort the term “ectopic pregnancy” using ICD-10 code and SNOMED concepts between 1/1/13 and 2/28/2022 were used to identify our population of interest. Chart review including diagnosis, surgical history, current and previous medications, and disease activity at the time of conception was then performed. Pregnancy specific variables include age at time of conception, parity, history of previous pregnancy loss, history of Caesarean section, or endometriosis. Results: 20,624 legal sex females with CD, UC or IBD were identified and 335 patients were diagnosed with a pregnancy event with all of their care at our center. 6 patients were diagnosed with an EP. Of interest, only 4 had their EP after an established diagnosis of UC or CD. Of these 4 patients, 3 had UC and 1 had CD. Duration of disease prior to EP ranged from 6 months to 4 years. Of the 3 patients with UC, all were in remission on either aminosalicylate or anti TNF therapy. The patient with CD had mild activity, was status post one resection and on no medication at the time of the EP. None had other common risk factors for EP. Conclusion: EP in our practice was uncommon, with an incidence of only 2%. Whether this is because of improved control of disease activity or preconception counseling has yet to be determined. Larger population-based studies are needed to assess the impact of newer medical therapies and disease management on the risk of this pregnancy outcome.

Prevalence and associated risk factors of ectopic pregnancy among pregnant women at El-Galaa Teaching Hospital

Background Ectopic pregnancy (EP) is a major contributing factor to the burden of maternal mortality and morbidity in the early half of pregnancy. The aim of study was to assess the prevalence of EP in women under study and determine the risk factors of EP in the study sample. Design A descriptive exploratory design was adopted in this study. Sample A convenience sample of 121 women who were diagnosed with EP were included, whereas those who were diagnosed with intrauterine pregnancies were excluded from the study. Tool A structured interviewing questionnaire was used to collect data related to sociodemographic characteristic, medical surgical, and obstetric history. Results The prevalence of EP in the current study was 0.52, 0.62, and 0.72% in 2018, 2019, and 2020, respectively. Risk factors of EP were grand multigravidity (55.2%), history of abortion (43.3%), history of pelvic inflammatory diseases (40%), history of abdominal and pelvic surgery (22.60%), history of infertility (19.1%), history of assisted reproductive technology usage (16.5%), failure of intrauterine devices (13.3%), history of previous EP (9.2%), and history of cesarean section deliveries more than three (5.8%) times sequentially. Conclusion EP is an increasingly common and potentially catastrophic condition. The prevalence of EP among women who present to emergency with first trimester bleeding or pain or both was matched with the worldwide prevalence. Risk factors of EP were seen in grand multigravida, abortion, and pelvic inflammatory disease, being the most common risk factors of EP. Recommendations Early diagnosis of an EP via detailed history, focusing on identification of risk factors for EP, will promote successful medical management, thus reducing surgical intervention and ultimately reducing maternal morbidity/mortality with preservation of future fertility.

Emergency department point-of-care ultrasound diagnosis of a complete molar pregnancy presenting as first trimester bleeding.

Emergency department point-of-care ultrasound diagnosis of a complete molar pregnancy presenting as first trimester bleeding.

A Study of Maternal and Foetal Outcome in Pregnant Women with History of First Trimester Vaginal Bleeding

BACKGROUND&#x0D; First trimester vaginal bleeding is an obstetric high-risk, early registration of pregnancy regular antenatal visits and good awareness to the pregnant women and their family members about first trimester vaginal bleeding and the sequelae and the early and remote obstetric and neonatal outcome are needed. The purpose of the study was to observe the effect of first trimester bleeding on maternal &amp; foetal outcomes.&#x0D; METHODS&#x0D; This study involved all women attending the antenatal clinic at the Department of Obstetrics and Gynaecology with a history of vaginal bleeding in the first trimester or the second trimester or third trimester with prior history of first trimester bleeding at Basaveshwar and Sangameshwar Hospital, attached to MRMC, Kalaburagi. It included a total of 100 singleton pregnant women with vaginal bleeding in the first trimester of pregnancy that was confirmed ultrasonographically. Patients were closely observed and follow-up done 2 weekly up to 36 weeks and weekly after that till delivery. The maternal and foetal outcomes were studied.&#x0D; RESULTS&#x0D; In the present study, first trimester vaginal bleeding was seen maximum in the age group of 21-25 years about 47 %, seen more in Multigravida 52% than primigravida 44% and 4% in Grandmultipara. Maternal adverse outcomes such as abruption in 8 % of cases, placenta pravia in 15% of cases, placenta accreta in 2 % of cases, preeclampsia in 12 % of cases and PROM in 18 % of cases and preterm labour in 21 % of cases were observed. Among 63 live births, 38 were term babies, 19 were early preterm, 2 were late preterm babies, and 8 were IUGR babies.&#x0D; CONCLUSIONS&#x0D; In the first trimester, vaginal bleeding is one of the predictors of poor maternal and foetal outcomes later in pregnancy. Both maternal and foetal outcomes are studied considering pregnant women with first-trimester vaginal bleeding as a high-risk category. Proper evaluation of a pregnant woman with first-trimester vaginal bleeding, regular antenatal care, methodical evaluation of bleeding and regular follow-up with the lookout for maternal and foetal complications and awareness to the woman and family members and knowledge about warnings signs in pregnancy to be explained. Proper clinical examination and ultrasonographic evaluation &amp; timely obstetric consultation and interventions play an important role in the management of patients with first-trimester vaginal bleeding.