title: The clinical significance of bleeding during the second trimester of pregnancy.
abstract: 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.
authors: 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.
authors: Arie
authors: A
authors: Koifman
authors: Amalia
authors: A
authors: Levy
authors: Yaron
authors: Y
authors: Zaulan
authors: Avi
authors: A
authors: Harlev
authors: Moshe
authors: M
authors: Mazor
authors: Arnon
authors: A
authors: Wiznitzer
authors: Eyal
authors: E
authors: Sheiner
mesh_terms: 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*