Perinatal outcomes of second trimester antenatal genital bleeding

Abstract

Perinatal outcomes of second trimester antenatal genital bleeding C.Chollet1, B. Andre1, M. Voglimacci1, A. Ghassani1, O. Parant1,2,3, P. Guerby1 1CHU Toulouse, Pôle de Gynécologie Obstétrique, Hôpital Paule de Viguier, Toulouse 2Université de Toulouse III, UMR1027, Toulouse. 3INSERM, UMR1027, Toulouse (France) Summary Objective: To evaluate the prognosis of singleton pregnancies complicated by genital bleeding during the 2nd trimester and to iden- tify the factors associated with poor perinatal outcome. Materials and Methods: We conducted a retrospective study (January 2009 to December 2012), which included all women presenting with midtrimester bleeding (15 to 27 weeks of gestation). The cases were com- pared with women without bleeding, who delivered in our center during the same period. Results: Ninety-seven women were included (0.57% of the overall singleton births). An underlying placental cause was discovered by ultrasound in 56% of the cases (low-lying pla- centa, partially detached placenta or a combination of both of these pathologies). We report a significantly increased rate of preterm birth (47.4% vs. 12.2%; RR=3.9), perinatal mortality (11.3% vs. 1.3%; RR=8.8), PPROM (16.5% vs. 3.7%; RR=4.5; CI 95% [2.8-7.1]), and cesarean section (42.3% vs. 21%; RR=2; CI 95% [1.6-2.5]) in the bleeding group. The factors associated with preterm birth were re- current bleeding (OR=4.7), gestational age > 22 WG at the first bleeding (OR=3.7), and low-lying placenta. Conclusion: Despite a low incidence, the occurrence of bleeding in the 2nd trimester of pregnancy should alert the physician because of increased perinatal morbi- mortality. These patients may thus require increased monitoring. Key words: Vaginal bleeding; Ultrasound; Second trimester of pregnancy; Adverse pregnancy outcomes; Preterm delivery