Gebeliğin Birinci ve İkinci Trimesterinde Görülen Vajinal Kanama ile Kötü Obstetrik Sonuçlar Arasındaki İlişki
Abstract
Amaç: Abortus imminens 20.gestasyonel haftadan önce servikal değişiklikler olmaksızın vajinal kanama görülmesi olarak tanımlanır ve gebelik sonuçlarını etkileyen bir klinik durumdur. Çalışmamızın amacı abortus imminensin (Aİ) gebeliğin birinci veya ikinci trimesterinde izlenmesinin obstetrik sonuçlara etkisini araştırmaktır.
Gereç ve Yöntem: Bu retrospektif çalışmaya Ocak 2017 ve Aralık 2019 yılları arasında erken gebelik servisine Aİ nedeniyle yatışı olan 831 tekil gebelik dahil edildi. Aİ tanısını aldığı gestasyonel haftaya göre olgular 1. ve 2. trimester (Grup 1 ve Grup 2) olmak üzere ikiye ayrılarak obstetrik sonuçlar karşılaştırıldı.
Bulgular: Toplam 831 olgunun 622’si (%75,8) grup 1’e ve 209’u (%25,2) grup 2’ye ait idi. Grup 1’dekilerin %51,1’inde ve grup 2’dekilerin %44,2’sinde hematom mevcuttu (p=0,075). Gebeliğin sonlandığı gestasyonel hafta grup 2’dekilerde daha uzundu (33,04±8,8 karşın 28,14±13,94, p<0,05). Grup 1’dekilerin %31,5’i abortusla, %11,9’u preterm doğumla ve %56,6’sı term doğumla sonuçlanırken, grup 2’dekilerde bu oranlar sırasıyla %17,7, %21,1 ve %61,2 olarak saptanmıştır (p=0,000). Gebeliğin geç komplikasyonları olarak grup 1 ve grup 2 karşılaştırıldığında sırasıyla, hipertansif hastalık (%3,5 ve %6,2), intrauterin gelişim geriliği (%4,5 ve %4,8), prematür preterm membran rüptürü (%2,7 ve %9,1) ve plasenta previa (%0,8 ve %1,9) olarak bulunmakla beraber bu komplikasyonlar grup 2 olgularında daha sık saptanmıştır.
Sonuç: Aİ’in saptandığı trimestere göre klinik özellikleri ve sonuçları değişmektedir. 2. trimesterde görülen Aİ olgularında daha sık preterm doğum ve gebeliğin geç komplikasyonları gelişebilirken, 1. trimesterdekilerde ise daha sık abortusla sonuçlandığı akılda tutulmalıdır.
Keywords
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References
- Simpson JL, Mills JL, Holmes LB et al. Low fetal loss rates after ultrasound-proved viability in early pregnancy. JAMA 1987; 258: 2555–2557.
- Yıldız Ç, et al. First-trimester sonographic diagnosis of massive subchorionic hemorrhage: a case report. Cumhuriyet Medical Journal. 2009; 31(1): p. 71-74.
- Axelsen SM, Henriksen TB, Hedegaard M, Secher NJ. Characteristics of vaginal bleeding during pregnancy. Eur J Obstet Gynecol Reprod Biol. 1995;63:131–134.
- Weiss JL, Malone FD, Vidaver J, et al. Threatened abortion: a risk factor for poor pregnancy outcome. a population-based screening study. Am J Obstet Gynecol 2004; 190: 745–750.
- Sharami S.H, et al. The relationship between vaginal bleeding in the first and second trimester of pregnancy and preterm labor. Iran J Reprod Med. 2013;11(5):385-390.
- Karim SA, Bakhtawar I, Butta AT, Jalil M. Effects of first and second trimester vaginal bleeding on pregnancy outcome. J Pak Med Assoc. 1998;48:40–42.
- Bang S.W, Lee S.S. The factors affecting pregnancy outcomes in the second trimester pregnant women. Nutr Res Pract 2009; 3(2):134-140.
- Laraia BA, Siega-Riz AM, Gunderson C, Dole N. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr 2006;136:177–182.
- Nanda K, Lopez L.M, Grimes D.A, Peloggia A, Nanda G. Expectant care versus surgical treatment for miscarriage. The Cochrane database of systematic reviews, 2012(3), CD003518.
- Bever A.M, Pugh S.J, Kim S, et al. Fetal Growth Patterns in Pregnancies With First-Trimester Bleeding. Obstet Gynecol 2018; 131(6):1021-1030.
- Velez Edwards D.R, Baird D.D, Hasan R, Savitz D.A, Hartmann K.E. First-trimester bleeding characteristics associate with increased risk of preterm birth: data from a prospective pregnancy cohort. Hum Reprod 2012; 27(1): 54–60.
- Harville E.W, Wilcox A.J, Baird D.D, Weinberg C.R. Vaginal bleeding in very early pregnancy. Human Reproduction 2003;18(9):1944-1947.
- Hasan R, Baird D.D, Herring A.H, Olshan A.F, Jonsson Funk M.L, Hartmann K.E. Association between first-trimester vaginal bleeding and miscarriage. Obstet Gynecol 2009;114(4):860-867.
- Weiss J.L, Malone F.D, Vidaver J, et al. & FASTER Consortium Threatened abortion: A risk factor for poor pregnancy outcome, a population-based screening study. Am J Obstet Gynecol 2004;190(3):745-750.
- Towers C.V, Burkhart A.E. Pregnancy outcome after a primary antenatal hemorrhage between 16 and 24 weeks’ gestation. Am J Obstet Gynecol 2008;198(6):684.e1-5.
- Magann E.F, Cummings J.E, Niederhauser A, Rodriguez- Thompson D, McCormack R, Chauhan S.P. Antepartum bleeding of unknown origin in the second half of pregnancy: a review. Obstet Gynecol Surv 2005;60(11):741-745.
- Bhandari S, Raja E.A, Shetty A, Bhattacharya S. Maternal and perinatal consequences of antepartum haemorrhage of unknown origin. BJOG 2014;121(1):44-50.
- Ball RH, Ade CM, Schoenborn JA, Crane JP. The clinical significance of ultrasonographically detected subchorionic hemorrhages. Am J Obstet Gynecol 1996;174(3):996-1002.
- Pedersen J.F and M. Mantoni M. Large intrauterine haematomata in threatened miscarriage. Frequency and clinical consequences. Br J Obstet Gynaecol 1990;97(1):75-77.
The Relationship Between Vaginal Bleeding in The First and Second Trimester of Pregnancy and Poor Obstetric Outcomes
Abstract
Aim: Abortus imminens is defined as the occurrence of vaginal bleeding without cervical changes before the 20th gestational week and is a clinical condition that affects pregnancy outcomes. The aim of this study is to investigate the effect of monitoring abortus imminens (AI) in the first or second trimester of pregnancy on obstetric outcomes.
Materials and Methods: Between January 2017 and December 2019, 831 singleton pregnancies with hospitalization to service due to AI were included in this retrospective study. Obstetric results were compared by dividing the cases into 1st and 2nd trimesters (group 1 and group 2) according to the gestational week at which the AI was diagnosed.
Result: Of the 831 cases, 622 (75.8%) were in group 1 and 209 (25.2%) were in group 2. Hematoma was present in 51.1% of those in group 1 and 44.2% of those in group 2 (p=0.075). The gestational week when the pregnancy ended was longer in group 2 (33.04±8.8 vs. 28.14±13.94, p<0.05). While 31.5% of those on group 1 resulted in abortion, 11.9% of them resulted in preterm birth and 56.6% in term birth. These rates were found to be 17.7%, 21.1% and 61.2% for those in group 2, respectively (p=0.000). Late complications of pregnancy in group 1 versus group 2 were hypertensive disease (3.5% vs. 6.2% respectively), intrauterine growth retardation (4.5% vs. 4.8%), preterm premature rupture of membranes (2.7% vs. 9.1%), and placenta previa (0.8% vs. 1.9%). Complications were more common in group 2 cases.
Conclusion: The clinical features and results of AI vary according to the trimester in which it was detected. While preterm labor and late complications of pregnancy may develop more frequently in cases of AI seen in the second trimester, it should be kept in mind that it results in abortion more often in the first trimester.
Project Number
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References
- Simpson JL, Mills JL, Holmes LB et al. Low fetal loss rates after ultrasound-proved viability in early pregnancy. JAMA 1987; 258: 2555–2557.
- Yıldız Ç, et al. First-trimester sonographic diagnosis of massive subchorionic hemorrhage: a case report. Cumhuriyet Medical Journal. 2009; 31(1): p. 71-74.
- Axelsen SM, Henriksen TB, Hedegaard M, Secher NJ. Characteristics of vaginal bleeding during pregnancy. Eur J Obstet Gynecol Reprod Biol. 1995;63:131–134.
- Weiss JL, Malone FD, Vidaver J, et al. Threatened abortion: a risk factor for poor pregnancy outcome. a population-based screening study. Am J Obstet Gynecol 2004; 190: 745–750.
- Sharami S.H, et al. The relationship between vaginal bleeding in the first and second trimester of pregnancy and preterm labor. Iran J Reprod Med. 2013;11(5):385-390.
- Karim SA, Bakhtawar I, Butta AT, Jalil M. Effects of first and second trimester vaginal bleeding on pregnancy outcome. J Pak Med Assoc. 1998;48:40–42.
- Bang S.W, Lee S.S. The factors affecting pregnancy outcomes in the second trimester pregnant women. Nutr Res Pract 2009; 3(2):134-140.
- Laraia BA, Siega-Riz AM, Gunderson C, Dole N. Psychosocial factors and socioeconomic indicators are associated with household food insecurity among pregnant women. J Nutr 2006;136:177–182.
- Nanda K, Lopez L.M, Grimes D.A, Peloggia A, Nanda G. Expectant care versus surgical treatment for miscarriage. The Cochrane database of systematic reviews, 2012(3), CD003518.
- Bever A.M, Pugh S.J, Kim S, et al. Fetal Growth Patterns in Pregnancies With First-Trimester Bleeding. Obstet Gynecol 2018; 131(6):1021-1030.
- Velez Edwards D.R, Baird D.D, Hasan R, Savitz D.A, Hartmann K.E. First-trimester bleeding characteristics associate with increased risk of preterm birth: data from a prospective pregnancy cohort. Hum Reprod 2012; 27(1): 54–60.
- Harville E.W, Wilcox A.J, Baird D.D, Weinberg C.R. Vaginal bleeding in very early pregnancy. Human Reproduction 2003;18(9):1944-1947.
- Hasan R, Baird D.D, Herring A.H, Olshan A.F, Jonsson Funk M.L, Hartmann K.E. Association between first-trimester vaginal bleeding and miscarriage. Obstet Gynecol 2009;114(4):860-867.
- Weiss J.L, Malone F.D, Vidaver J, et al. & FASTER Consortium Threatened abortion: A risk factor for poor pregnancy outcome, a population-based screening study. Am J Obstet Gynecol 2004;190(3):745-750.
- Towers C.V, Burkhart A.E. Pregnancy outcome after a primary antenatal hemorrhage between 16 and 24 weeks’ gestation. Am J Obstet Gynecol 2008;198(6):684.e1-5.
- Magann E.F, Cummings J.E, Niederhauser A, Rodriguez- Thompson D, McCormack R, Chauhan S.P. Antepartum bleeding of unknown origin in the second half of pregnancy: a review. Obstet Gynecol Surv 2005;60(11):741-745.
- Bhandari S, Raja E.A, Shetty A, Bhattacharya S. Maternal and perinatal consequences of antepartum haemorrhage of unknown origin. BJOG 2014;121(1):44-50.
- Ball RH, Ade CM, Schoenborn JA, Crane JP. The clinical significance of ultrasonographically detected subchorionic hemorrhages. Am J Obstet Gynecol 1996;174(3):996-1002.
- Pedersen J.F and M. Mantoni M. Large intrauterine haematomata in threatened miscarriage. Frequency and clinical consequences. Br J Obstet Gynaecol 1990;97(1):75-77.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Research Article |
| Authors | |
| Project Number | Yok |
| Publication Date | September 22, 2022 |
| Acceptance Date | August 23, 2022 |
| Published in Issue | Year 2022 Volume: 4 Issue: 3 |
