Probability of early pregnancy loss in women with vaginal bleeding and a singleton live fetus at ultrasound scan

Abstract

Bleeding is a common feature of early pregnancy affecting about one-fifth of pregnant women in the first trimester. The chance of miscarriage after bleeding and a live fetus at scan has not previously been defined precisely. The purpose of this study was to evaluate the outcome of early pregnancies with a viable singleton fetus that had been complicated by bleeding. A prospective study was performed on 370 women with a singleton live fetus who had presented to the early pregnancy assessment clinic (EPAC) with vaginal bleeding. Women were grouped into light, moderate and heavy loss according to the self-assessed degree of vaginal bleeding. The women were also categorised according to the presence or absence of an intrauterine haematoma. The overall spontaneous miscarriage rate in the study was 11.1%; almost 90% of pregnancies continued to viability. Women with moderate or heavy bleeding had more than twice the rate of miscarriage compared with those with light bleeding. A total of 14% of the women had an intrauterine haematoma and those women were 2.6 times more likely to miscarry than those without (23% vs 9%). This relationship appeared to hold true even after controlling for blood loss. The data presented can be used to guide women with a live fetus about the chance of miscarriage after an episode of vaginal bleeding. We propose that a large multi-centre study should be undertaken to define precisely the risk miscarriage for each gestational week according to a range of clinical and ultrasound characteristics.

Do Women with Pain and Bleeding in Early Pregnancy Require a Vaginal Speculum Examination as Part of Their Assessment?

“…The miscarriage rate was 83.3, 50 and 24.7% in women who complained of heavy, moderate and light bleeding, respectively. The same was found in another study that showed women who reported moderate or heavy bleeding had more than twice the rate of miscarriage compared to those with light bleeding [8]. More recently, bleeding scores have been shown to be useful variables in the prediction of pregnancy outcome, especially if they are used in combination with ultrasound variables [9,10].…”

Symptoms of an Intrauterine Hematoma Associated with Pregnancy Complications: A Systematic Review

“…But they ignored the impact of its concrete characteristics, such as the size, position, gestational age at diagnosis, duration or the simultaneous presence or absence of vaginal bleeding [2], [50], [51]. Even though many studies compared the symptoms in relation to the pregnancy complications, most of them were limited or small uncontrolled series, including without a clear definition of hematomas’ type and poor classification criteria as mentioned.…”

Assessment and Management of Bleeding in the First Trimester of Pregnancy

“…Women reporting moderate to heavy bleeding had more than twice the rate of spontaneous abortion compared with those reporting light bleeding (24.1% versus 9%; P = .003). They also reported, however, that 75% of women with heavy bleeding continued the pregnancy to viability 3 …”

“…The amount of bleeding, along with other symptoms such as pain, identifies the urgency of the visit and contributes to the signs and symptoms that are considered part of a differential diagnosis. In a recent prospective study of 370 women with a positive pregnancy test and vaginal bleeding, the authors defined light bleeding as lighter than a period, moderate bleeding as similar to a period, and heavy bleeding as heavier than a period 3 . Women reporting moderate to heavy bleeding had more than twice the rate of spontaneous abortion compared with those reporting light bleeding (24.1% versus 9%; P = .003).…”

“…It has been reported that 50% of women presenting to an emergency room with vaginal bleeding will go on to have a normal pregnancy 1 . Vaginal bleeding is a common event in the first trimester, reported to occur in 15% to 25% of all pregnancies 1–10 . Bleeding can be a normal sign of implantation of the pregnancy, may herald the initiation of spontaneous abortion, or may be the sign of a pathologic condition, such as ectopic pregnancy or gestational trophoblastic disease (GTD).…”