The clinical significance of bleeding during the second trimester of pregnancy.
OBJECTIVE
This study aimed at investigating the clinical importance and pregnancy outcome in women suffering from bleeding during the second half of their pregnancies.


METHODS
A population-based study including all deliveries between the years 1988 and 2005 was conducted. Comparison was performed between patients with and without vaginal bleeding during the second half of pregnancy. Pregnancies, which terminated before 22 weeks, multiple gestations and women lacking prenatal care were excluded from the analysis. Stratified analyses, using the Mantel-Haenszel technique, and a multiple logistic regression model were performed to control for confounders.


RESULTS
During the study period, 175,093 singleton deliveries occurred in our institute. Of these, 2,010 (1.1%) were complicated with bleeding upon admission during the second half of pregnancy. The cases were mostly attributed to placental abruption (63.5%; n = 1,276) and placenta previa (36.5%; n = 734). Independent risk factors associated with bleeding, using a backward, stepwise multivariate analysis were oligohydramnios, polyhydramnions, [odds ratio (OR) = 1.6; 95% confidence interval (CI) 1.2-2.0; P = 001 and 1.5; 1.2-1.8; P < 0.01, respectively], suspected intra uterine growth restriction (IUGR, 3.2; 2.6-4.0; P < .001), gestational age, previous abortions and maternal age. These patients subsequently were more likely to deliver by cesarean section (CS, 72.9 vs. 12.1%, OR = 19.5; 95% CI 17.6-19.9; 14.9 vs. 1.1%; P < 0.001). Perinatal mortality among patients admitted due to second half bleeding was significantly higher as compared to patients without bleeding (P < .001).


CONCLUSIONS
Bleeding upon admission during the second half of pregnancy is an independent risk factor for perinatal mortality. Careful surveillance, including fetal monitoring, is suggested in these cases in order to reduce the adverse perinatal outcome.
Koifman
Arie
A
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben Gurion University of the Negev, PO Box 151, Beer-Sheva, Israel.
Levy
Amalia
A
Zaulan
Yaron
Y
Harlev
Avi
A
Mazor
Moshe
M
Wiznitzer
Arnon
A
Sheiner
Eyal
E
D000028:Abortion, Induced; D000037:Abruptio Placentae / Q000453:epidemiology; D000328:Adult; D001034:Apgar Score; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D005317:Fetal Growth Retardation / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008423:Maternal Age; D015999:Multivariate Analysis; D016104:Oligohydramnios / Q000453:epidemiology; D010923:Placenta Previa / Q000453:epidemiology; D006831:Polyhydramnios / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012307:Risk Factors; D014592:Uterine Hemorrhage / Q000453:epidemiology*