Second-trimester vaginal bleeding: Correlation of ultrasonographic findings with perinatal outcome

• Published in: American journal of obstetrics and gynecology 1998-02, Vol.178 (2), p.336-340
• Main Authors: Signore, Caroline C., Sood, Anil K., Richards, Douglas S.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Case-Control Studies; Diseases of mother, fetus and pregnancy; Female; Fetal Death - epidemiology; Gynecology. Andrology. Obstetrics; high-risk pregnancy; Humans; Intensive Care, Neonatal; Medical sciences; Obstetric Labor, Premature - epidemiology; Parity; Placenta Previa - complications; Pregnancy; Pregnancy Complications, Cardiovascular - diagnostic imaging; Pregnancy Outcome; Pregnancy Trimester, Second; Pregnancy. Fetus. Placenta; Retrospective Studies; Risk Factors; Second-trimester bleeding; Ultrasonography; ultrasonography in pregnancy; Uterine Hemorrhage - diagnostic imaging
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/S0002-9378(98)80022-7

Objective: Our purpose was to determine the relationship between ultrasonographic findings and perinatal outcome in patients with second-trimester vaginal bleeding. Study Design: A retrospective case-control study was performed. One hundred sixty-seven patients with ultrasonographic examinations performed for bleeding between 13 and 26 weeks' gestation were identified through a comprehensive ultrasonography database. The main ultrasonographic findings of interest were the presence of an intrauterine clot, membrane separation, and placenta previa. A control group of 167 patients was obtained by selecting the next consecutive patient from the comprehensive perinatal database. Perinatal outcome measures for both groups were recorded. Results: Multiparity was more common in patients with bleeding than in controls (69% vs 58%, p=0.036), as was history of two or more previous preterm deliveries (6% vs none, p=0.005). Second-trimester vaginal bleeding was associated with increased risk of preterm delivery (relative risk 1.9, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 6.3, 95% confidence interval 1.9 to 2.1), and perinatal death (relative risk 5.4, 95% confidence interval 2.1 to 13.7). The perinatal mortality rate was 162:1000 in these patients versus 30:1000 in controls. To assess the impact of ultrasonographic abnormalities, the study group was divided into two groups. Among the patients with second-trimester vaginal bleeding those with abnormal ultrasonographic findings had an increased risk of preterm delivery (relative risk 2.0, 95% confidence interval 1.4 to 2.8), fetal death (relative risk 2.6, 95% confidence interval 1.1 to 6.3), perinatal death (relative risk 2.6, 95% confidence interval 1.3 to 5.3), and neonatal intensive care unit admissions (relative risk 3.2, 95% confidence interval 1.6 to 6.1). The perinatal mortality rate was 258:1000 for patients with abnormal ultrasonographic examinations. Conclusion: Second-trimester vaginal bleeding is more common in multiparous women and in women with a history of a previous preterm delivery. Perinatal morbidity and mortality is increased in patients with bleeding during the second trimester. The risk is compounded when abnormalities are detected by ultrasonography.