Pregnancy outcome after first trimester vaginal bleeding

Background: First trimester vaginal bleeding is one of the most common complications in pregnancy threatening its proper development and successful outcome.Methods: A case-control study was conducted from October 2016 to April 2018 in the department of obstetrics and gynecology SKIMS.200 cases with vaginal bleeding in first trimester were taken for study. Out of the cases, number of patients who had abortion, ectopic, molar pregnancy or continued their pregnancy beyond 20 weeks was noted. Those who continued their pregnancy were compared with 130 controls for complications developing later in pregnancy.Results: There was significantly higher incidence of PIH (15.4% of cases, 6.9% of controls, p value = 0.005) and abruption (7.7% and 1.5% among cases and controls respectively with p-value of 0.034) among cases than controls. Mean gestational age at delivery in cases was 35.6±3.63 weeks while in controls it was 38.5±1.94 weeks (p value <0.001). Mean birth-weight of the neonates in cases was 2.16±0.78 kgs while in controls was 3.05±0.53 kgs (p value <0.001). IUGR occurred in 9.2% of cases and 3.1% of controls (p value 0.039). There was significantly higher neonatal ICU admission rate in cases than controls (p value 0.019).Conclusions: Patients with first trimester vaginal bleeding are at increased risk for spontaneous loss and adverse pregnancy outcome.

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A COMPARATIVE STUDY OF MATERNAL OUTCOME IN FIRST-TRIMESTER VAGINAL BLEEDING IN THE DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY, SMS MEDICAL COLLEGE, JAIPUR

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i7.2006 ◽

2021 ◽

Vol 5 (7) ◽

Author(s):

Savita Meena ◽

Suniti Verma ◽

R N Sehra ◽

Suman Choudhary

Keyword(s):

Gestational Age ◽

Vaginal Bleeding ◽

Adverse Pregnancy Outcome ◽

First Trimester ◽

Control Group ◽

Case Group ◽

Medical College ◽

Obstetrics And Gynaecology ◽

Increased Risk ◽

Adverse Pregnancy

Background: The outcome of ongoing pregnancies after first trimester vaginal bleeding is of relevance to women and obstetricians for planning antenatal care and clinical interventions in pregnancy. Hence, this study was conducted to identify the risks associated with first trimester bleed which may facilitate decision making regarding mode, place and timing of delivery during management, which may improve maternal and neonatal outcome. Methods: Hospital based comparative prospective study conducted at Department of Obstetrics and Gynaecology, SMS Medical College & associated Hospitals, Jaipur. Results: APH was found in 4 (8.00%) patients of case group and nil in control group. So, APH was found to be more in the case group than control group but was statistically not significant. Pre-eclampsia was found in 4 (8.00%) in case group and 3 (6.00%) in control group with statistically insignificant difference between the two groups. 26 (52.00%) delivered at the gestational age of ?37 weeks, whereas only 8 (16%) of control group delivered at ?37 weeks. So, the gestational age at delivery of control group subjects was found to be higher as compared to case group subjects and the difference was statistically significant (p=0.001). Conclusion: Threatened miscarriage in early pregnancy increases the risk of adverse pregnancy outcome. In our study, these patients were found to be at an increased risk of preterm delivery, PPROM. Keywords: PROM, Miscarriage, Gestational age

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Subchorionic hematoma. Causes, pathogenesis, diagnostic and treatment management

Journal of obstetrics and women s diseases ◽

10.17816/jowd62437-47 ◽

2013 ◽

Vol 62 (4) ◽

pp. 37-47 ◽

Cited By ~ 2

Author(s):

Julia Viktorovna Kovalyova

Keyword(s):

Pregnancy Outcome ◽

Early Pregnancy ◽

Adverse Pregnancy Outcome ◽

First Trimester ◽

Pregnancy Complication ◽

Treatment Management ◽

Live Embryo ◽

Increased Risk ◽

Threatened Abortion ◽

Adverse Pregnancy

Threatened abortion is one of the most common complications of early pregnancy. In the presence of a live embryo, the most frequently encountered sonographic finding is a subchorionic hematoma. Resent studies suggest that the presence of intrauterine hematoma during the first trimester may identify a population of patients at increased risk for adverse pregnancy outcome. In the review the etiology, pathogenesis of subchorionic hematoma and diagnostic and treatment management of patients with such pregnancy complication are described.

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Uterine Artery Doppler in the Prediction of Preeclampsia and Adverse Pregnancy Outcome

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1134 ◽

2010 ◽

Vol 4 (2) ◽

pp. 117-122

Author(s):

George Daskalakis ◽

Aris Antsaklis

Keyword(s):

Pregnancy Outcome ◽

Uterine Artery ◽

Adverse Pregnancy Outcome ◽

False Positive Rate ◽

First Trimester ◽

Maternal Serum ◽

Uterine Artery Doppler ◽

Mortality And Morbidity ◽

Increased Risk ◽

Adverse Pregnancy

Abstract Preeclampsia and fetal growth restriction are major causes of perinatal mortality and morbidity. Several studies have shown that a generalized endothelial dysfunction is associated with these complications. Clinical trials have shown that pregnant women who demonstrate high resistance in uteroplacental blood flow are at higher risk for preeclampsia. Uterine artery Doppler studies both in the second and the first trimester can predict pregnancies at increased risk of the complications of impaired placentation. The sensitivity for predicting severe preeclampsia ranges between 80 and 90% for a false positive rate of 5 to 7%. Uterine artery Doppler screening at 20 to 24 weeks’ gestation is superior to first trimester screening, and appears to fulfill the requirements for a worthwhile screening test. Further research is needed to better assess the value of various combinations of uterine artery Doppler and maternal serum markers, for the prediction of adverse pregnancy outcome.

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Pregnancy-Associated Infections

Tutorial Topics in Infection for the Combined Infection Training Programme ◽

10.1093/oso/9780198801740.003.0048 ◽

2019 ◽

Author(s):

Anna Riddell ◽

Michael Millar

Keyword(s):

Preterm Birth ◽

High Risk ◽

Hepatitis B ◽

Bacterial Vaginosis ◽

Pregnancy Outcome ◽

Adverse Pregnancy Outcome ◽

First Trimester ◽

Increased Risk ◽

Adverse Pregnancy ◽

In Pregnancy

An important consideration in pregnancy is the relationship between infection in the mother and the developing foetus. Infections can indirectly impact the foetus through effects on the mother, for example, maternal urinary tract infection is associated with preterm birth, or can infect the foetus. Routes of infection can be ascending from the birth canal through the cervical os, transplacentally, or rarely, contiguously. The effect on the mother is also important: pregnancy is considered an immunosuppressive state and the growing foetus causes significant mechanical and physiological changes. Although the first trimester is the key developmental phase for the growing foetus, during the third trimester the mother is more susceptible to severe respiratory infection and some viral infections such as varicella zoster virus (VZV), due to the mechanical changes produced by the growing foetus. There is a paucity of evidence supporting the safety of drugs in pregnancy. Use of any medicinal drug in pregnancy, including antibiotics, requires good reasons. The optimum choice of antibiotics depends on the trimester of the pregnancy. In general, beta-lactams are safe and tetracyclines should be avoided throughout pregnancy. Nitrofurantoin is safe until after thirty-five weeks gestation and trimethoprim should be avoided in the first trimester but is safe otherwise (perhaps with folic acid supplementation if < 20 weeks). Specific patterns of colonization and infection of the genitourinary tract can be associated with an increased risk of an adverse pregnancy outcome, particularly preterm birth. Sexually transmitted diseases such as gonorrhoea and chlamydia are associated with an increased risk of spontaneous preterm birth, which may extend to infection in the pre-conception period. Bacterial vaginosis is an abnormal pattern of vaginal colonization and is also linked with an increased risk of preterm birth. The US Center for Disease Control recommends screening all pregnant women for chlamydia, gonorrhoea, syphilis, HIV, and hepatitis B, symptomatic women for trichomonas and genital herpes, women considered at high risk of preterm birth for bacterial vaginosis, and women at high risk of blood-borne virus infection for hepatitis C. Treatment is administered to reduce the risk of an adverse pregnancy outcome (syphilis, gonorrhoea, chlamydia, trichomonas, and bacterial vaginosis) or to prevent transmission to the infant (herpes, HIV, hepatitis B, and C).

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First and second trimester bleeding and pregnancy outcome: a prospective study in a tertiary government hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20196050 ◽

2019 ◽

Vol 9 (1) ◽

pp. 371

Author(s):

Chaithra M. ◽

Anitha G. S. ◽

Sukanya Suresh ◽

Savitha C.

Keyword(s):

Prospective Study ◽

Pregnancy Outcome ◽

Vaginal Bleeding ◽

Perinatal Death ◽

Adverse Pregnancy Outcome ◽

Placenta Previa ◽

Bleeding Risk ◽

Second Trimester ◽

Increased Risk ◽

Adverse Pregnancy

Background: Bleeding in first and second trimester of pregnancy is one of the common complications of pregnancy. there is evidence from various prospective and retrospective studies that first and second trimester vaginal bleeding which continue with pregnancy is associated with adverse pregnancy outcome, including preterm delivery, low birth weight babies, perinatal death and congenital anomalies. Objective of this study was to know the outcome of pregnancies who have bleeding in first and second trimester of pregnancy.Methods: This study was prospective study done in the department of obstetrics and gynaecology, Vanivilas Hospital, Bangalore from September 2018 to August 2019.Results: This study concludes that I trimester vaginal bleeding are at increased risk of abortion than in II trimester vaginal bleeding. Risk of placenta previa was more in II trimester vaginal bleeding than in I trimester vaginal bleeding.Conclusions: This study concludes that I trimester vaginal bleeding are at increased risk of abortion than in II trimester vaginal bleeding. Risk of placenta previa was more in II trimester vaginal bleeding than in I trimester vaginal bleeding. Bleeding in I trimester and II trimester call for special attention in view of increased risk of preterm birth and perinatal death. Recognition of these association will be useful for detection and follow up of pregnancies being at high risk.

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POS0737 LOW PRECONCEPTIONAL COMPLEMENT LEVEL IS RELATED WITH ADVERSE OBSTETRIC OUTCOME IN A MULTICENTRIC COHORT OF PREGNANCY IN PATIENTS WITH APS AND APL POSITIVITY

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1824 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 619.2-620

Author(s):

D. Lini ◽

C. Nalli ◽

L. Andreoli ◽

F. Crisafulli ◽

M. Fredi ◽

...

Keyword(s):

Pregnancy Outcome ◽

Complement Activation ◽

Pregnancy Complications ◽

Antiphospholipid Antibodies ◽

Pregnancy Loss ◽

Adverse Pregnancy Outcome ◽

Obstetric Outcome ◽

Complement Level ◽

Increased Risk ◽

Adverse Pregnancy

Background:The role of complement in the antiphospholipid (aPL) related pathology has been widely studied in animal models. Antiphospholipid antibodies can induce fetal loss in experimental animals but mice deficient in specific complement components (C4, C3, C5) appear somehow protected. In addition, in pregnant mice injected with aPL, antibody deposition has been found at decidual level causing focal necrosis, apoptosis and neutrophil infiltrates and supporting aPL pathogenetic potential. On the other hand, human studies did find hypocomplementemia associated to pregnancy complications in patients with obstetric antiphospholipid syndrome (APS). These results, however, are not unanimously confirmed and, in addition, some studies only show increased levels of complement activation products (i.e. Bb) and not decreased levels of C3 and/or C4. A recently study focusing on complement level in early pregnancy and before pregnancy showed a significant correlation with pregnancy complications and loss in a large cohort of primary APS.Objectives:To investigate if the simple detection of low C3 and/or C4 could be considered a risk factor for adverse pregnancy outcome in APS and aPL carriers pregnancies.Methods:We performed a multicentric study including patients from 10 Italian and 1 Russian Centers. Data on pregnancies in women with primary APS (n=434) and asymptomatic carriers with persistently positive aPL but not fulfilling clinical criteria for APS (n=218) were retrospectively collected. Serum C3 and C4 levels were evaluated by nephelometry; hypocomplementemia was defined by local laboratory reference values. Statistical analysis was performed using GraphPad.Results:Preconceptional complement levels and gestational outcome were available for 107 (25%) pregnancies in APS out of 434 and for 196 (90%) pregnancies in aPL carriers women out of 218. In pregnancies with low preconceptional C3 and/or C4, a significantly higher prevalence of pregnancy losses was observed (p=0.019). A subgroup analysis focusing on triple aPL positive patients was also performed. Preconceptional low C3 and/or C4 levels were found to be associated with an increased rate of pregnancy loss (p = 0.027) in this subgroup also. Otherwise, adverse pregnancy outcomes in single or double aPL positive women were not related to preconception complement levels (p = 0.44) (Table 1). Of note, all the pregnancy losses in the triple positive group occurred in patients treated with low dose aspirin and low molecular weight heparin from the time of positive pregnancy test.Conclusion:Our findings confirm that decreased complement levels before pregnancy are associated with increased risk of adverse outcome. This has been seen only in in women with triple aPL positivity, indeed single or double positivity does not show this trend. Complement levels are cheap and easy to be measured therefore they could represent a useful aid to identify patients at increased risk of pregnancy loss. test positivity.References:[1]De Carolis S, et al. Complementemia and obstetric outcome in pregnancy with antiphospholipid syndrome. Lupus (2012) 21:776–8.[2]Kim MY, et al. Complement activation predicts adverse pregnancy outcome in patients with systemic lupus erythematosus and/or antiphospholipid antibodies. Ann Rheum Dis (2018) 77:549–55.[3]Fredi M, et al. Risk Factors for Adverse Maternal and Fetal Outcomes in Women With Confirmed aPL Positivity: Results From a Multicenter Study of 283 Pregnancies. Front Immunol. 2018 May 7;9:864.Triple aPL positivitySingle or double aPL positivityGestational outcomeLow C3/C4 (n=49)Normal C3/C4(n=17)pLow C3/C4 (n=57)Normal C3/C4(n=165)pTerm live birth (>37w)15 (31%)6 (35%)ns34 (60%)110 (67%)nsPreterm live birth (≤37w)22 (45%)11 (65%)ns15 (26%)38 (23%)nsPregnancy losses (abortion and miscarriages)12 (24%)0 (0%)0.0278 (14%) 17 (10%)nsDisclosure of Interests:None declared

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