Pregnancy Outcome in Women Presenting with Per Vaginal Bleeding in First Trimester of Pregnancy

Author(s): Dr. Sabiha Islam, Dr. Salma Akter Munmun, Dr. Shah Aziz, Dr Romena Afroj

Background:

The first trimester of pregnancy, from the last menstrual period to the end of the 13th week, is a critical period marked by significant changes and rapid development. Vaginal bleeding occurs in 16-25% of pregnancies and is linked to a higher risk of complications. Causes include implantation bleeding, miscarriages, ectopic pregnancy, cervical pathology, and molar pregnancy. Miscarriages affect about 20% of pregnancies, while ectopic pregnancies affect 1.1%. Bleeding can cause anxiety but does not always result in pregnancy termination, and it increases the risk of complications such as preterm delivery, low birth weight, and maternal complications, necessitating close monitoring.

Aim of the study:

This study aims to assist general physicians, emergency department doctors, and obstetricians in managing the uncertainties associated with early pregnancy bleeding and to improve counseling practices.

Methods:

This prospective observational study was conducted at the Department of Obstetrics and Gynecology (indoor and outdoor) in Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2023 December 2023. Seventy-five pregnant women with first-trimester bleeding were enrolled and analyzed over one year from (start) to (end). Participants had amenorrhea, a positive pregnancy test, and bleeding within the first 12 weeks. Clinical history and gynecological exams were done at the booking visit, with follow-up in antenatal clinics and repeated ultrasounds as needed.

Result:

This study involved 75 participants, focusing on women with firsttrimester vaginal bleeding. Most women (52%) were aged 30-35 years, with a mean BMI of 25.71±2.53 kg/m². Parity distribution was 52% primigravida and 48% multigravida. 52% had no relevant conception history; 38.67% conceived spontaneously, 6.67% used IVF, and 2.67% IUI. Previous complications included first-trimester bleeding (26.67%) and missed abortion (4%). Specific conditions were rare. Multiple bleeding episodes were reported by 64%, with 40% having fresh bleeding. Premature labor was the most common complication (28%). Full-term delivery occurred in 40% of cases, with 13.33% experiencing IUGR or preterm delivery.

Conclusion:

This study highlights the diverse outcomes of pregnancies with first-trimester vaginal bleeding, ranging from full-term deliveries to complications and losses. Emphasizing the importance of individualized care and early intervention, it suggests developing specific management protocols and conducting long-term follow-ups to improve maternal and fetal health outcomes.

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