Early and late pregnancy complications in women who experience first trimester vaginal bleeding at a University Hospital, Benin City, Nigeria

Abstract

Background: Vaginal bleeding in pregnancy is usually an alarming experience for pregnant women and this remains one common reason for them to present to the early pregnancy assessment unit (EPAU).

Objective: We sought to document pregnancy failure and risk of placenta praevia complicating first trimester bleeding per vagina (PVB), and to examine the influence of recurrent PVB on specific materno-fetal outcomes.

Method: Early pregnancy PVB managed in the EPAU was reviewed and women who reported first trimester PVB at the time of  antenatal booking were recruited along with controls. Both groups were prospectively studied until delivery. The diagnosis of  placenta praevia and the development of other maternal or fetal complications were noted. The association between clinical presentation and pregnancy outcome was analyzed using cross-tabulations with SPSS.

Results: PVB was reported by 7.5% of women seen in the EPAU. At booking, 14 women with early PVB and 51 controls were recruited. The experience of PVB was associated with delivery before 34 weeks (RR 3.3 with 95%CI: 1.34-7.99; P= 0.06), birth asphyxia (RR 3.7 with 95%CI: 1.59-8.50; P = 0.01) and low birth weight (RR 7.3 with 95%CI: 3.24-16.59; P = 0.001). Recurrent PVB was associated with 85.7% risk of placenta praevia.

Conclusion: Vaginal bleeding in early pregnancy can predict placenta praevia, and is associated with preterm delivery and birth asphyxia. Early identification of women who bleed in pregnancy will be instructive in their successful monitoring and delivery. We advocate a deliberate enquiry about PVB in the booking clinic.

Key words: First trimester vaginal bleeding, Miscarriage, Adverse pregnancy outcomes, Placenta praevia