Maternal and perinatal consequences of antepartum haemorrhage of unknown origin

Abstract

Objective To explore the risk of adverse maternal and perinatal outcomes in women with antepartum bleeding of unknown origin (ABUO).Design Cohort study based on data extracted from the Aberdeen Maternity and Neonatal Databank. Exposure was antepartum haemorrhage occurring after the first trimester not attributable to placenta praevia or placental abruption.Setting Aberdeen Maternity Hospital, Aberdeen, Scotland, UK.Population All primigravidae delivering between 1976 and 2010.Methods Data were analysed using univariate and multivariate statistical methods.Main outcome measures Pre-eclampsia, induced labour, mode of delivery, preterm delivery, postpartum haemorrhage, admission to neonatal unit, perinatal death.Results Between 1976 and 2010, there were 7517 women with ABUO and 68 423 women without ABUO in the cohort. Women with ABUO were more likely to be non-smokers, belong to a lower social class, and have a higher body mass index. ABUO was a significant risk factor for induced labour (adjusted odds ratio, aOR, 1.23; 95% CI 1.16-1.31), preterm delivery at <37 weeks of gestation (aOR 2.30; 95% CI 2.11-2.50), and postpartum haemorrhage (aOR 1.15; 95% CI 1.06-1.25). There was no significant association detected with pre-eclampsia (aOR 0.93; 95% CI 0.83-1.05). Whereas there was an increased risk of low birthweight (aOR 0.90; 95% CI 0.79-1.03) and stillbirth (aOR 0.92; 95% CI 0.66-1.30) with ABUO on univariate analysis, once adjusted for confounding factors this risk was non-significant.Conclusion Pregnancies complicated by ABUO are at a greater risk of preterm delivery and induced labour. There was no increase seen in perinatal mortality after adjusting for preterm birth.

Unexplained antepartum haemorrhage – a risk factor for preterm labour and delivery

“…However, the authours could not comment conclusively from their dataset on whether this was due to spontaneous preterm labour or induction of labour before term. 1 Our retrospective comparative cohort study using individual case records in a National Health Service hospital in the UK suggested that in cases of unexplained APH, preterm delivery (<37 weeks) is attributed to spontaneous preterm labour (15.4% in unexplained APH versus 5.9% in controls; P < 0.001). 4 We were able to address this issue only because individual case notes were reviewed in this retrospective cohort study, where maternal and perinatal outcomes of 287 women with unexplained APH were compared with the outcomes of 424 controls macthed for age, parity and day of delivery.…”

“…The interesting article by Bhandari et al 1 has inspired us to put forward a few comments/queries regarding their study design and its interpretation. This retrospective cohort study included routinely coded data from a databank.…”

Predictive factors for perinatal death in nuchal cord cases: a case control study

“…This is not a surprising finding, as antepartum hemorrhage is a widely known risk factor for stillbirth or perinatal death. [11][12][13] Therefore its association with nuchal cord might increase this risk.…”

Authors’ reply: Unexplained antepartum haemorrhage – a risk factor for preterm labour and delivery

“…We thank Drs Jana, Barik and Arora for their interest in our paper 1 . The authors have raised some valid issues which we will try to clarify.…”