Neonatal Uterine Bleedings: An Ignored Sign but a Possible Cause of Early-Onset Endometriosis – A Systematic Review

Dekker, Joost; Hooijer, Isabelle N.; Ket, Hans; Vejnović, Ana-Marija; Benagiano, Giuseppe; Brosens, Ivo; Mijatovic, Velja

doi:10.1159/000512663

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…Based on our retrospective search of medical records during two different time periods of 2013-2017 and 1996-2000, we further con rmed that visible uterine bleeding indeed occurs with a prevalence of 3.1% and 9.7%, respectively. Our ve years retrospective nding during the period of 2013-2017 coincided with the previously published prevalence of 3-5% [7,8,19]. The three-fold difference in NUB prevalence during the period of 1996-2000 can be explained by the increasing distribution of younger maternal age and birth at longer gestational week.…”

Section: Discussionsupporting

confidence: 88%

Association between neonatal uterine bleeding and endometriosis-related symptoms later in life

Ogawa

Khan

Kuroboshi

et al. 2022

Preprint

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Background: Neonatal uterine bleeding (NUB) is reported to be involved in early onset endometriosis. There is no information whether young women with a history of NUB may manifest various symptoms related to endometriosis. In the present study we investigated the possible association between NUB and endometriosis-related symptoms later in life who are now adults. Methods: This is a retrospective case-controlled cohort study and prospective evaluation of questionnaire-based symptoms related to endometriosis among young women born with and without NUB. The prevalence of NUB was calculated and multiple logistic regression analysis with variable confounding factors was conducted to identify risk factors of NUB. The results of web-based questionnaire survey were analyzed by continuous variables using Wilcoxon rank sum test and categorical variables using Fisher’s exact test to compare endometriosis-related symptoms. Results: Among 807 female babies born at our hospital between 2013 and 2017, NUB occurred in 25 cases with a prevalence of 3.1%. Twenty-five NUB cases showed overt bleeding 4.5±1.8 days after birth (median 4 days, range 1-8 days) and it lasted for 1.4±0.8 days (median 1 day, range 1-4 days). Multiple logistic regression analysis indicated that younger age of the mother ((OR, 0.92, 95% CI 0.85-1.00, P=0.048)) and longer gestational age of 39 weeks (OR 3.04, 95% CI 1.43-6.45, P=0.004) and ≥40 weeks (OR 4.54, 95% CI 2.20-9.39, P<0.0001) of gestation were significantly associated with the occurrence of NUB. Young women with or without a history of NUB during the period of 1996-2000 manifested various endometriosis-related symptoms.Conclusion: We confirmed the validity of the reported prevalence and risk factors of NUB. Young mothers and longer gestational age are the risk factors of NUB and newborn females with or without NUB similarly suffer from various endometriosis-related symptoms later in life. Future prospective cross-sectional study is warranted to confirm the endometriosis-related symptoms in NUB+ cases by physical examination/ultrasound/MRI or laparoscopy. Trial registration: not applicable

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Section: Discussionsupporting

confidence: 88%

Association between neonatal uterine bleeding and endometriosis-related symptoms later in life

Ogawa

Khan

Kuroboshi

et al. 2022

Preprint

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“…The serious long-term morbidity of IH and other genital tract outflow obstruction with accumulated secreted mucous and menstrual blood is retrograde menstruation and endometriosis which starts manifesting in adolescents at menarche or in neonatal period in phenomenon known as neonatal menstruation or neonatal uterine bleedings (NUB) leading to what is called early onset endometriosis (EOE) caused by early neonatal migration of menstrual material into peritoneum [18]. Neonatal uterine bleedings, which mostly observed in first week, is an ignored sign of EOE.…”

Section: Discussionmentioning

confidence: 99%

Hymen-saving hymenotomy of imperforate hymen in neonates and adolescents: tertiary medical center experience

Aljahdali

Kurdi

2022

Ann Pediatr Surg

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Background Imperforate hymen (IH) is the most common obstructive anomaly of female genital tract. Hymen saving has a great importance for both cultural and religious reasons. Conventional surgical treatment for this condition is cruciate incision hymenotomy or hymen-saving central annular hymenotomy (HSCAH). This study aimed to review presentations and management of neonate and adolescents with IH at one tertiary hospital over 12 year’s period. The aim also was to stress upon importance of hymen saving to our Muslim community and improve knowledge, enable targeted education, and reduce unnecessary tests and diagnostic delay for this condition. Methods Twenty-five patients with IH were diagnosed and treated in this retrospective cohort study over 12 years, from January 2010 till December 2021. Demographic characteristics of the patients, their symptoms and signs, investigations, type of operations, recurrence, and infections were recorded and analyzed. Results Saudi accounted for the majority of IH cases (88%). There were fifteen adolescents, and ten were neonates. Bulging imperforate hymen, pelvic/abdominopelvic mass, constipation, acute urine retention, abdominal discomfort, and lower abdominal distension were among the signs and symptoms. All 25 patients had HSCAH, 21 of whom had primary HSCAH and four of whom had secondary HSCAH due to recurrence. To avoid recurrence, HSCAH was performed with suturing of the inner vaginal mucosa to the exterior vestibular mucosa. Conclusion Early diagnosis of imperforate hymen for neonate and adolescent girls and prompt definitive HSCAH could have positive impact on treatment outcome and decrease complications and fulfill integrity of hymen as virginity of high importance in our Muslim community and other similar culture, where hymen-sparing procedure is preferred by most of these patients and families.

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“…NUB most commonly occurs between postnatal days 3 and 7 and lasts for 3-4 days [4]. The incidence was reviewed by Dekker et al [4].…”

Section: The Evolution Of Concepts Behind Neonatal Uterine Bleedingmentioning

confidence: 99%

In Memory of Ivo Brosens: Reflections on the Pathophysiology of Neonatal Uterine Bleeding

Habiba¹,

Guo²,

Benagiano³

2023

Gynecol Obstet Invest

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Background: The occurrence of vaginal bleeding in early neonatal life has been observed for centuries and was considered a consequence of the sudden drop in circulating hormones following birth. As such, neonatal uterine bleeding was dismissed as having no clinical significance. Interest in the phenomenon was renewed when a new theory suggested a link between neonatal uterine bleeding (NUB) and accelerated endometrial maturation. This theory was based on the observation of a higher incidence of NUB in babies born post-term or after pregnancies complicated by intrauterine growth restriction, preeclampsia, or blood group incompatibility. Objective: The objective of this study was to review of available evidence on the pathogenesis of NUB. Method: Review of available literature using Medline search (August 2022, no limit on start date or language) to identify articles that may link NUB with features of the uterus and/or endometrium. Outcome: The fetal endometrial responses differ from that of the adult. In the fetus, the endometrium features progestogenic response only in a minority of cases. The endometrium in most newborn girls does not exhibit secretory or decidual changes which indicate lack of progesterone response. Most newborn girls do not have visible bleeding. Animal studies linked exogenous progestogen exposure during the period of organogenesis to poor endometrial gland development, progesterone resistance, and to alterations of reproductive performance. Although the fetal endometrium may not exhibit a full proliferative response, it is clearly sensitive to circulating estrogens. Molecular mechanisms involved in NUB may include “ontogenetic progesterone resistance.” Conclusion and Outlook: Endometrial development and its response to withdrawal of hormones at birth varies and may be affected by intrauterine stressors and gestational age. Factors that affect endometrial development during fetal life and in preterm neonates can have implications on future reproductive performance.

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Neonatal Uterine Bleedings: An Ignored Sign but a Possible Cause of Early-Onset Endometriosis – A Systematic Review

Cited by 12 publications

References 26 publications

Association between neonatal uterine bleeding and endometriosis-related symptoms later in life

Association between neonatal uterine bleeding and endometriosis-related symptoms later in life

Hymen-saving hymenotomy of imperforate hymen in neonates and adolescents: tertiary medical center experience

In Memory of Ivo Brosens: Reflections on the Pathophysiology of Neonatal Uterine Bleeding

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