Vaginal Bleeding In Early Pregnancy Research Articles

Maternal severe stressful life events and risk of abnormal vaginal bleeding among urban Chinese pregnant women

Objective: The objective of this study is to assess whether maternal stressful life events are associated with increased risk of vaginal bleeding in urban China.Methods: We implemented a cross-sectional study to examine the association between maternal severe stressful life events and vaginal bleeding in early pregnancy. Information was collected from an urban area and 956 participants were involved in final analysis. Multivariable logistic model was used to estimate the adjusted odds ratio (OR) and 95% confidence interval (95% CI) controlling for confounders.Results: In total, 219 of the 956 participants were reported vaginal bleeding. Maternal stressful life events would increase the chance of vaginal bleeding with a crude OR of 2.14 (95% CI, 1.53–2.99). After adjustment for potential variables, the association remains significant (adjusted OR, 2.22; 95% CI, 1.56–3.16), and stratification analysis shows parity is an influence factor. The frequency of maternal stress and vaginal bleeding exist a dose–response relationship.Conclusion: Maternal stressful life events are associated with the risk of vaginal bleeding in urban China. The parity status influences their association.

Anxiety associated with diagnostic uncertainty in early pregnancy

To determine anxiety levels of women presenting to an early pregnancy assessment unit (EPAU) with abdominal pain and/or vaginal bleeding and to assess how these levels change over time and according to ultrasonographic diagnosis. We undertook a prospective cohort study in an EPAU in a large UK teaching hospital. Women with abdominal pain and/or vaginal bleeding in early pregnancy (< 12 weeks' gestation) presenting for the first time were eligible for inclusion in the study. State anxiety levels were assessed using the standardized short form of Spielberger's state-trait anxiety inventory (STAI) on three occasions (before, immediately after and 48-72 hours after an ultrasound scan). Scores were correlated with ultrasonographic diagnosis. The diagnosis was either certain or uncertain. Certain diagnoses were either positive, i.e. a viable intrauterine pregnancy (IUP), or negative, i.e. a non-viable IUP or ectopic pregnancy. Uncertain diagnoses included pregnancy of unknown location and pregnancy of uncertain viability. Statistical analysis involved mixed ANOVAs and the post-hoc Tukey-Kramer test. A total of 160 women were included in the study. Anxiety levels decreased over time for women with a certain diagnosis (n = 128), even when negative (n = 64), and increased over time for women with an uncertain diagnosis (n = 32). Before the ultrasound examination, anxiety levels were high (STAI value, 21.96 ± 1.11) and there was no significant difference between the five groups. Immediately after the ultrasound examination, anxiety levels were lower in the viable IUP group (n = 64; 7.75 ± 1.13) than in any other group. The difference between the five groups was significant (P < 0.005). After 48-72 hours, women with a certain diagnosis had significantly lower anxiety levels than had those with an uncertain diagnosis (10.77 ± 4.30 vs 22.94 ± 1.65; P < 0.005). The experience of abdominal pain and/or vaginal bleeding in early pregnancy is highly anxiogenic. Following an ultrasound examination, the certainty of the diagnosis affects anxiety levels more than does the positive or negative connotations associated with the diagnosis per se. Healthcare providers should be aware of this when communicating uncertain diagnoses. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Chemotherapy in the Emergency Department? There Is a Role for That: Methotrexate for Ectopic Pregnancy.

Approximately 1.6% of all emergency department (ED) visits in the United States are for vaginal bleeding in early pregnancy, translating to around 500,000 ED visits per year. A potentially life-threatening condition, ectopic pregnancy occurs in 1.5%-2% of pregnancies. Many patients will require either surgical or pharmacological intervention following a positive diagnosis. With regard to pharmacological options, methotrexate, largely known for its use in the oncology arena, has emerged as the most effective nonsurgical option and the pharmacological agent of choice. However, this therapy is not without its own unique adverse event profile and patients should be adequately educated on the monitoring parameters of this pharmacotherapy.

Management of vaginal bleeding in early pregnancy in the emergency department

Management of vaginal bleeding in early pregnancy in the emergency department

Stillbirth and intrauterine fetal death: contemporary demographic features of >1000 cases from an urban population.

Of 780 000 births annually in the UK, around 3300 are stillborn, a rate of approximately 4 per 1000 births. Traditional epidemiological associations are based on historic data. The aim of this study was to document contemporary demographic findings in a large series of > 1000 deaths in utero in London and compare these with national datasets. From a dedicated database, including > 400 data fields per case, of fetal, infant and pediatric autopsies performed at Great Ormond Street Hospital and St George's Hospital, London, we extracted information on all intrauterine deaths, excluding terminations of pregnancy, from 2005 to 2013, inclusive. Demographic data were analyzed according to the gestational age at which fetal death occurred (second-trimester intrauterine fetal death (IUFD), subdivided into early (< 20 weeks) and late (20-23 weeks) IUFD, and third-trimester stillbirth (≥ 24 weeks)) and compared with national datasets when available, using Mann-Whitney U-test and comparison of proportions testing as appropriate. Data were available from 1064 individual postmortem reports examining intrauterine deaths delivered between 12 and 43 weeks' gestation, including 425 IUFDs (246 early and 179 late) and 639 stillbirths. Compared with the overall UK pregnant population, women in whom an intrauterine death occurred were significantly older and more obese. White mothers had a higher proportion of stillbirths (as opposed to IUFDs) than did non-white mothers, whereas black mothers had a higher proportion of IUFDs relative to stillbirths. Increased body mass index was associated with increased risk across all groups. Women who had uterine fibroids, those who had a history of vaginal bleeding in early pregnancy and those who had undergone assisted conception had a relatively higher proportion of IUFDs than stillbirths. Based on a large series of >1000 autopsies in cases of intrauterine death, these data highlight the increased risk for fetal loss associated with maternal demographic factors in contemporary clinical practice, particularly associations with increased maternal age and body mass index. Among women in whom an intrauterine death occurs, maternal ethnicity, mode of conception and gynecological history are associated with differing timing of fetal loss. Further research is required to understand the mechanisms involved in such maternal factors in order to develop preventative strategies. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Sonographic Detection of Ovarian Ectopic Pregnancy

Sonography is the imaging modality of choice to evaluate suspected intrauterine and extrauterine pregnancies. Determining the anatomic location of an ectopic pregnancy can be challenging, particularly when the ectopic is located external to the fallopian tube. Ovarian ectopic pregnancy is one of the rarest forms of nontubal ectopics. This report documents one such uncommon case of ovarian pregnancy in a woman presenting with light vaginal bleeding in early pregnancy, with subsequent rupture and laparotomy. Histopathologic analysis confirmed the diagnosis of ovarian ectopic pregnancy.

Placenta accreta located in the posterior wall of the uterus: a case report

It is thought that abnormal invasive implantation of the placenta occur as a result of the defect came decidua basalis only in women who have a history of cesarean section previously. Massive obstetric hemorrhage has increased in placenta accreta. Despite the ultrasound, doopler ultrasound and magnetic resonance, in early pregnancy weeks the diagnosis of plecenta accreta is reduced. Therefore, the presence of life-threatening vaginal bleeding in early pregnancy we have to suspect from placenta accreta. We will publish here, the second trimester uterine placenta accreta cases showing the placement of the rear well.

Imaging of vaginal bleeding in early pregnancy

Imaging of vaginal bleeding in early pregnancy

Risk of Vaginal Bleeding and Postpartum Hemorrhage After Use of Antidepressants in Pregnancy

This study aimed to examine obstetric bleeding outcomes after exposure during pregnancy to selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic (TCAs), and other antidepressants (OADs).The Norwegian Mother and Child Cohort Study and the Medical Birth Registry of Norway constituted the data source for the present study. We included 57,279 pregnant women, of which 1.02% reported use of antidepressants during pregnancy, mostly SSRIs/SNRIs (0.92%). We categorized exposure according to antidepressant use in pregnancy (SSRIs/SNRIs, n = 527; TCAs/OADs, n = 59; nonexposed, nondepressed, n = 55,411) with inclusion of a disease comparison group (nonexposed, depressed, n = 1282). We used logistic regression to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI) for vaginal bleeding outcomes in pregnancy and postpartum hemorrhage.Compared with nonexposed subjects, first trimester exposure to SSRIs/SNRIs or TCAs/OADs did not confer any increased risk of vaginal bleeding in early pregnancy (aOR, 0.91; 95% CI, 0.72-1.16 and aOR, 0.83; 95% CI, 0.36-1.92, respectively). No increased risk for vaginal bleeding in midpregnancy was observed among users of SSRIs/SNRIs (aOR, 0.81; 95% CI, 0.50-1.31) or TCAs/OADs (aOR, 0.96; 95% CI, 0.26-3.53) in second trimester. Exposure to SSRIs/SNRIs during gestational week 30 to childbirth did not confer any increased risk of postpartum hemorrhage after vaginal (aOR, 0.90; 95% CI, 0.47-1.74) or cesarean (aOR, 1.47; 95% CI, 0.51-4.22) delivery. Women in the disease comparison group presented a significant moderate increased risk of vaginal bleeding in early pregnancy (aOR, 1.22; 95% CI, 1.06-1.39) and midpregnancy (aOR, 1.28; 95% CI, 1.07-1.55) but not postpartum.Among this Norwegian cohort of pregnant women, use of antidepressants in pregnancy was not associated with any obstetrical bleeding outcome.

Pregnancy outcome after use of cranberry in pregnancy – the Norwegian mother and child cohort study

BackgroundCranberry is one of the most commonly used herbs during pregnancy. The herb has been used traditionally against urinary tract infections. No studies are found that specifically address the risk of malformations after use of cranberry during pregnancy. The aim of the study was to investigate the safety of cranberry use during pregnancy, including any effects on congenital malformations and selected pregnancy outcomes.MethodsThe study is based on data from The Norwegian Mother and Child Cohort Study including more than 100,000 pregnancies from 1999 to 2008. Information on use of cranberry and socio-demographic factors was retrieved from three self-administered questionnaires completed by the women in pregnancy weeks 17 and 30, and 6 months after birth. Information on pregnancy outcomes was retrieved from the Medical Birth Registry of Norway.ResultsAmong the 68,522 women in the study, 919 (1.3%) women had used cranberry while pregnant. We did not detect any increased risk of congenital malformations after use of cranberry. Furthermore, the use of cranberry was also not associated with increased risk for stillbirth/neonatal death, low birth weight, small for gestational age, preterm birth, low Apgar score (<7), neonatal infections or maternal vaginal bleeding in early pregnancy. Although an association was found between use of cranberry in late pregnancy and vaginal bleeding after pregnancy week 17, further sub-analyses of more severe bleeding outcomes did not support a significant risk.ConclusionsThe findings of this study, revealing no increased risk of malformations nor any of the following pregnancy outcomes; stillbirth/neonatal death, preterm delivery, low birth weight, small for gestational age, low Apgar score and neonatal infections are reassuring. However, maternal vaginal bleeding should be investigated further before any firm conclusion can be drawn. Treatment guidelines on asymptomatic bacteriuria in pregnancy recommend antimicrobial therapy as the first line treatment. According to our data and the outcomes studied, cranberry does not appear to be a harmful adjunctive self-treatment.

Adverse Outcomes in Twin Pregnancies Complicated by Early Vaginal Bleeding

Objective We sought to estimate the risks of adverse pregnancy outcomes associated with early vaginal bleeding in twin pregnancies. Study Design In a retrospective cohort study of consecutive twin pregnancies undergoing anatomic survey, we compared women who reported vaginal bleeding at Results Of 2106 pregnancies meeting inclusion criteria, 175 reported vaginal bleeding. Twin pregnancies with early vaginal bleeding had significantly higher risks of abruption, PPROM, and preterm birth compared to twin pregnancies without bleeding. The findings were similar when twin pairs were stratified by parity or maternal comorbidities. Conclusion Twin pregnancies complicated by vaginal bleeding in early pregnancy have an increased risk of abruption, PPROM, and preterm birth

A Comparison of Confirmed Intrauterine Pregnancy by Ultrasound In Patients With Vaginal Bleeding in Early Pregnancy With HCG levels Above and Below 2000

A Comparison of Confirmed Intrauterine Pregnancy by Ultrasound In Patients With Vaginal Bleeding in Early Pregnancy With HCG levels Above and Below 2000

Adverse outcomes in twin pregnancies complicated by early vaginal bleeding

We sought to estimate the risks of adverse pregnancy outcomes associated with early vaginal bleeding in twin pregnancies. In a retrospective cohort study of consecutive twin pregnancies undergoing anatomic survey, we compared women who reported vaginal bleeding at <22 weeks to those who did not. Exclusion criteria included monoamniotic pregnancies, twin-to-twin transfusion syndrome, and placenta previa. Primary outcomes included preeclampsia, abruption, preterm premature rupture of membranes (PPROM), preterm birth <34 weeks, and intrauterine growth restriction. Of 2106 pregnancies meeting inclusion criteria, 175 reported vaginal bleeding. Twin pregnancies with early vaginal bleeding had significantly higher risks of abruption, PPROM, and preterm birth compared to twin pregnancies without bleeding. The findings were similar when twin pairs were stratified by parity or maternal comorbidities. Twin pregnancies complicated by vaginal bleeding in early pregnancy have an increased risk of abruption, PPROM, and preterm birth <34 weeks.

Vaginal Bleeding in Early Pregnancy and Associations with Physical, Psychological and Environmental Factors among Chinese Women: From the C-ABC Cohort Study

Objectives: To examine sociodemographic, physical, psychological and environmental factors that may be associated with vaginal bleeding (VB) in the first trimester. Methods: A questionnaire survey was conducted on 14,752 women by trained doctors, when pregnant women came for the first antenatal examination, including sociodemographic characteristics, prior adverse pregnancy outcomes, diseases history, life event stress, adverse environmental exposure and detailed information on VB. Results: VB occurred among 3,466 pregnant women, the prevalence of VB was 23.4% in the first trimester, 35.9% of whom did not see a doctor, 59.7% of whom went to clinic and only 4.4% of whom were hospitalized for VB. Multinomial logistic regression demonstrated that the following risk factors may be associated with VB with seeing a doctor: age >25 years, education greater than primary school, urban residence, prior spontaneous abortion, prior surgical abortion and previous stillbirth, having gynecological inflammation, chest X-ray examination and life events stress score >2 during the periconception period. Age >25 years, urban residence, prior surgical abortion, having gynecological inflammation and a life event stress score >2 during the periconception period may be related to VB without seeing a doctor. Conclusions: This epidemiologic study provided more information on predictors of VB: physical, psychological and adverse environmental exposure were all associated with VB in the first trimester.

Vaginal bleeding in early pregnancy and circulating markers of thrombin generation

Objective: To determine if subjects experiencing acute vaginal bleeding in early pregnancy have increased plasma markers of thrombin generation compared to nonbleeding controls. Methods: Subjects with clinically apparent acute (within 24 h of sample collection) vaginal bleeding between 6 and 20 weeks estimated gestational age and without known thrombophilias were enrolled, along with nonbleeding controls, and underwent collection of maternal plasma. Concentrations of thrombin-antithrombin (TAT) and fragment 1 + 2 (F1 + 2) were determined by enzyme-linked immunosorbent assay. Differences between bleeding and nonbleeding subjects were assessed through linear regression with adjustment for gestational age. Results: Twenty subjects with vaginal bleeding and 20 controls were included. Bleeding was significantly associated with increased concentrations of TAT (p = 0.007) and F1 + 2 (p = 0.044) when corrected for gestational age. Among bleeding subjects, there was no association between markers of thrombin generation and the subject’s description of bleeding quantity, though higher concentrations were associated with a longer self-reported duration of bleeding. Conclusions: Clinically apparent vaginal bleeding in early pregnancy is associated with increased circulating maternal markers of thrombin generation. Thus, these maternal markers may have a future role in risk stratification.

Current Resources for Evidence‐Based Practice January/February 2012

The Institute of Medicine Report on Clinical Preventive Services for Women: From Evidence to Policy As a central component of the Affordable Care Act (ACA), new health insurance plans will be required to cover preventive health services without cost sharing to plan members beginning on or after August 1, 2012. In response to this directive within the ACA, the United States Department of Health and Human Services (HHS) charged the Institute of Medicine (IOM) with conducting a comprehensive review of women’s preventive health services and recommending those services deemed necessary for the health of women in the United States (Gee et al, 2011).

Antepartum haemorrhage of unknown origin and maternal cigarette smoking beyond the first trimester

Antepartum haemorrhage of unknown origin (APHUO) is associated with preterm birth and perinatal mortality. To determine whether smoking beyond the first trimester of pregnancy was an independent risk factor for APHUO. Rates of APHUO were compared between non-smokers and smokers, and non-smokers and ceased smokers. Participants were healthy nulliparous women recruited to the Screening for Pregnancy Endpoints (SCOPE) prospective cohort study in New Zealand, Australia, Ireland and United Kingdom. Logistic regression was used to compare adjusted odds ratio, 95% confidence intervals (OR, 95% CI) of APHUO between continued smokers and non-smokers, adjusting for possible confounders. Of the 3513 participants, 77.9% (n = 2737) were non-smokers, 10.6% (n = 371) ceased in the first trimester and 11.5% (n = 405) continued smoking beyond the first trimester. APHUO rates were higher in smokers than nonsmokers (7.4%, n = 30 vs 4.5%, n = 122; P = 0.01), but there was no difference between ceased smokers and nonsmokers (4.3%, n = 16 vs 4.5%, n = 122; P = 0.90). Smoking was no longer significantly associated with APHUO after adjustment for confounders (adjusted OR = 1.28, 95% CI 0.76–2.14), but vaginal bleeding in early pregnancy (adjusted OR = 2.98, 95% CI 2.12–4.18) and overweight/obesity (adjusted OR = 1.43, 95% CI 1.02–1.99) were independent risk factors. First trimester folic acid use was associated with a reduced risk (adjusted OR = 0.44, 95% CI 0.25–0.77). Smoking is not an independent risk factor for APHUO after adjustment for confounders, but other risk and protective factors have been identified.

Vaginal bleeding in early pregnancy and preterm birth: systemic review and analysis of heterogeneity

Objective. To systemically review published studies of vaginal bleeding and the risk of preterm birth (PTB) and explore sources of heterogeneity between them.Methods. The literature was searched for peer-reviewed articles from 1980 to 2009 in which the primary analysis was the risk of PTB among low-risk subjects with and without bleeding. Heterogeneity was assessed through I2 statistics, and sources of heterogeneity were explored through subgroup analyses and meta-regression.Results. 218 studies were initially identified, 64 reviewed and 23 included. The pooled Odds Ratio for PTB was 1.74, though significant heterogeneity was present (I2 = 49.7%). Meta-regression demonstrated a significant association between a study's incidence of bleeding and quality assessment and subsequent odds ratio, such that studies with a lower quality assessment or lower incidence of bleeding demonstrated an increased odds of PTB.Conclusions. Bleeding in early pregnancy is associated with an increased risk of PTB; however, excessive heterogeneity exists among published studies. The heterogeneity arises in part from differences in the reported incidence of bleeding within study populations. Presumably studies that identify bleeding in a larger percentage of subjects consequently dilute the magnitude of the risk.

HCG as a patient

hCG as a patient

Assessment and Management of Bleeding in the First Trimester of Pregnancy

Vaginal bleeding occurs in 15% to 25% of early pregnancies. While 50% of women who have vaginal bleeding in the first trimester of pregnancy will continue to have a viable pregnancy, the event creates significant anxiety for the woman and can be managed in a multitude of ways. The 3 main differential diagnoses associated with vaginal bleeding are spontaneous abortion, ectopic pregnancy, and gestational trophoblastic disease. This article reviews early pregnancy development, etiologies of vaginal bleeding in the first trimester, strategies for evaluation, and recognition and management of the main diagnostic considerations. Case study examples illustrating the complexity of the assessment and management of vaginal bleeding in early pregnancy are presented.