Association Between First-Trimester Vaginal Bleeding and Miscarriage

Hasan R, Baird DD, Herring AH, et al. Obstet Gynecol 2009;114:860–7
      Vaginal bleeding is a common first-trimester complication of many pregnancies. Most studies that address this topic enroll women who present to the emergency department, selecting for more serious cases of bleeding, which may mark the actual miscarriage event. In comparison, this observational cohort study evaluated bleeding episodes that were temporally separate from miscarriage in 4510 pregnant women. Information about the timing, heaviness, color, and duration of vaginal bleeding was gathered via telephone interviews. Additional information about the presence of pain was also collected. In an effort to control for confounders, the authors excluded bleeding within 4 days of miscarriage. The study demonstrated a strong association between “heavy” bleeding (defined as at least 1 day of bleeding when the flow was as heavy or heavier than the heavy flow of a usual menstrual period) and miscarriage, odds ratio (OR) 2.97 (95% confidence interval [CI] 1.93–4.56). This association was even stronger when the heavy bleeding was accompanied by pain (OR 4.79, 95% CI 2.97–7.73). Conversely, women with “spotting” (bleeding noted only when wiping) or “light bleeding” (lighter than the heavy flow of a usual menstrual period) were not significantly more likely to miscarry than women without bleeding, regardless of whether pain accompanied the bleeding. Adjustments for age, prior miscarriage history, and smoking did not significantly affect the estimates.
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