Antepartum bleeding of unknown origin in the second half of pregnancy and pregnancy outcomes

Abstract

Objective The purpose of our investigation was to evaluate factor(s) associated with unexplained antepartum bleeding of unknown origin (ABUO) after 24 weeks of pregnancy and correlate unexplained haemorrhage with maternal and perinatal outcomes.Design This is a retrospective observational study.Setting King Edward Memorial Hospital (KEMH), Subiaco, Western Australia.Population Singleton pregnancies delivering at KEMH between January 1998 and December 2004.Methods ABUO was defined as bleeding after 20 weeks of gestation but before the onset of labour with no cause detected on vaginal examination or abdominal ultrasound. Outcomes of these pregnancies were collated and compared with those of pregnancies without ABUO.Main outcome measures Antepartum complications assessed included pre‐eclampsia/eclampsia, gestational diabetes and preterm birth. Intrapartum evaluations included labour inductions, mode of delivery and gestational age at delivery. Neonatal outcomes evaluated included birthweight, Apgar scores, newborn intensive care unit (NICU) admission, neonatal complications and risk of perinatal/neonatal death.Results Between January 1998 and December 2004, there were 26 583 deliveries without ABUO and 1431 with ABUO. Multivariable analyses of the ABUO effects revealed that ABUO was a simultaneously significant risk factor for term labour inductions (OR = 2.00, 95% CI: 1.72–2.32, P < 0.001), preterm delivery (OR = 4.31, 95% CI: 3.84–4.84, P < 0.001), NICU admission (OR = 1.23, 95% CI: 1.01–1.51, P = 0.042), hyperbilirubinaemia (OR = 1.29, 95% CI: 1.01–1.63, P = 0.041) and reduced birthweight (26 g, 95% CI: 3–50, P = 0.026).Conclusion Women with ABUO are at greater risk of preterm delivery, term labour induction and their neonates are at greater risk for NICU admissions, hyperbilirubinaemia and a reduced birthweight.

Maternal and perinatal consequences of antepartum haemorrhage of unknown origin

“…[5][6][7][8][9][10] Similarly, the results of studies conducted by Berkowitz et al, Signore et al, and Sipila et al [13][14][15] were also in agreement with the results of this study, which showed that women with ABUO were more than twice as likely to have preterm delivery. Applying Hill's criteria of causality, we can therefore say that at least in the case of preterm delivery, the association is likely to be causal.…”

“…This was supported by the results of McCormack et al, 10 who showed an elevated risk of induction at term among women with ABUO. Although it is difficult to be certain that the reason for induction of labour was mainly ABUO, adjusting for confounding factors should have addressed this uncertainty.…”

“…The increased rates of preterm delivery may also explain the non-significant association of ABUO with stillbirth found on multivariate analysis. Incidentally, Harlev et al and McCormack et al 8,10 also found a significantly lower risk of pre-eclampsia and eclampsia in women with ABUO. On the other hand, Koifman et al 9 reported an increased risk of pre-eclampsia in these women.…”

“…[5][6][7]10 This may be because the AMND collects data from Aberdeen Maternity Hospital, which is a tertiary maternity care hospital where complicated pregnancies are over-represented. Moreover, the current study was restricted to nulliparous women, where the prevalence of APH is known to be higher.…”

“…An updated search in Medline identified five additional articles assessing other adverse perinatal outcomes associated with ABUO, but considerable uncertainty remained with regard to associations with pre-eclampsia and eclampsia, induction of labour, operative delivery, preterm prelabour rupture of membranes (PPROM), and malpresentation and malposition. [6][7][8][9][10] Magann called for larger prospective studies with the ability to correct for confounding factors such as maternal age, parity, gestational age, and comorbidities. 5 Given the conflicting evidence surrounding the risks associated with ABUO and the uncertainity regarding its management, we aimed to assess the risks of adverse pregnancy outcomes associated with ABUO using our population-based database of routinely collected obstetric data.…”