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Early
Pregnancy Bleeding
Less Risky Than Thought
Excerpt
By K.L. Capozza,
HealthScoutNews
As many as 30 percent of women experience
bleeding during the first three months of pregnancy, yet until
recently little was known about how the symptom affects pregnancy
outcome.
Now, new research suggests that
while women with first trimester bleeding are more likely to have
a miscarriage than women who don't bleed, the risk is much lower
than had been thought. Although previous research had pinpointed
the risk of miscarriage after bleeding at up to 30 percent, the
new study shows the risk is actually less than 5 percent.
"If you have bleeding and
a viable pregnancy at the time of ultrasound, your chances of
going to term are very good," says lead author Dr. Joshua
Weiss of Columbia University in New York City.
Nonetheless, early bleeding should
be a red flag to physicians that patients should be closely monitored
and screened for pregnancy complications, Weiss adds.
That's because the study, based
on data collected from 13,752 women treated at 15 medical institutions,
also showed that women with first-trimester bleeding are more
likely to experience complications such as premature delivery
and hypertensive disorders. And it found that pregnancy outcomes
worsen when vaginal bleeding is heaviest.
Women with heavy bleeding were
between two times and four times more likely to experience a host
of complications that included premature labor, early membrane
rupture and separation of the placenta from the uterus.
"When a patient has heavy
bleeding, physicians should consider a cervical length scan as
well as a fetal growth scan at 28 to 36 weeks," Weiss says.
A number of factors cause vaginal
bleeding during the first trimester of pregnancy, including cervical
infection, spontaneous abortion or implantation of the fertilized
egg outside the uterus.
The study is important, in part,
because early bleeding is so alarming to women and yet so little
information is currently available to explain what the symptom
means for their pregnancy.
"When you have a patient that
has bleeding, there's really not a whole lot of data to counsel
them with. We hoped to find out: What are the outcomes? What are
the complications?" Weiss explains.
"We had thought that when
women present to you with bleeding in the first trimester, at
least a third would miscarry," adds Dr. Ashi Daftary, medical
director of maternal-fetal medicine at Magee-Womens Hospital at
the University of Pittsburgh.
The study's more conservative estimate
of miscarriage rates may influence the prognosis that doctors
convey to their patients, Daftary says.
"This study shows that there's
clearly an increase in miscarriage, but the overall risk is relatively
low. And once you clear the first trimester, the overall risk
is only less than 5 percent," he says.
Daftary notes, however, that one
limitation of the study design is that it examined the experience
of women close to the end of the first trimester, when vaginal
bleeding is usually less problematic. Women who bleed very early
in their pregnancy face a much higher risk of miscarriage, with
as many as 20 percent losing their pregnancy, he adds.
"The information you'd really
like to have is on the women who present even earlier, because
they're a very different population of women at higher risk,"
he says.
The findings were presented at
the annual meeting of the Society for Maternal-Fetal Medicine
in San Francisco, which ended over the weekend.
More information
For more on early pregnancy bleeding,
visit the University
of Michigan. For information on high-risk pregnancies, see
this.
Reference
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