The outcomes of vaginal bleeding in the first half of pregnancy at Songklanagarind Hospital

Abstract

Objective To determine the diagnosis of vaginal bleeding in the first half of pregnancy and pregnancy outcomes.

Subjects and Methods: A retrospective review was performed in pregnant women who had sponta neous vaginal bleeding in the first 20 weeks of pregnancy and attended the Obstetrics and Gynecology Department from 1996 to 1997. Clinical and ultrasonographic diagnosis were recorded. The outcomes of viable intrauterine pregnancy were followed until delivery unless a miscarriage occurred or patients were lost. Age, gravidity, previous history of abortion, duration of bleeding episode and gestational age at the first bleeding episode were reviewed.

Main outcome measures The clinical diagnosis of vaginal bleeding in the first half of pregnancy, the ultrasonographic diagnosis of threatened abortion, the ultrasound finding of viable intrauterine pregnancy and final pregnancy outcomes. The clinical characteristics of patients who had vaginal bleeding with viable intrauterine pregnancy and non-viable pregnancy were analyzed by chi-square test.

Results The clinical diagnosis of 460 pregnant women who had spontaneous vaginal bleeding in the first half of pregnancy were 28.9% threatened abortion, 25.9% incomplete abortion, 15.4% missed abortion, 12% blighted ovum, 7.8% ectopic pregnancy, 5.7% complete abortion, 2.2% inevitable abortion, 1.7% molar pregnancy and 0.4% inconclusive. Viable intrauterine pregnancy was diagnosed by ultrasound finding in 46.7% of the total 285 patients with threatened abortion. Seventy-one percent of patients had normal outcome before 20 weeks of gestation. Within this group, the term and preterm labor were found to be 75.5% and 10.7 % respectively. Gestational age at the first bleeding episode in the patients who had viable intrauterine pregnancy and non-viable pregnancy were significantly different (p=0.001).

Conclusions The outcomes of vaginal bleeding in the first half of pregnancy were 28.9% threatened abortion and 71.1% miscarriage. Approximately half of all threatened abortion was confirmed to have viable intrauterine pregnancy by ultrasonographic diagnosis. Gestational age at the first bleeding episode was significantly different between the patients who had vaginal bleeding with viable intrauterine pregnancy and non-viable pregnancy.