Clinical Approach to Pregnancy-Related Bleeding

Abstract

Vaginal bleeding is a common event during pregnancy. The incidence varies, ­ranging from 1 to 22% [1–3]. The source of bleeding is mostly maternal. The significance, initial diagnosis, and clinical approach to vaginal bleeding depend on the gestational age and the bleeding characteristics. Vaginal bleeding during early pregnancy is associated with a 1.6-fold increased risk of many adverse outcomes, including preterm labor (PTL) and preterm premature rupture of membranes (PPROM) [3]. As bleeding persists or recurs later in pregnancy, the risk of associated morbidities grows [4]. Although 50% of the women who suffer from vaginal bleeding during early pregnancy go on to have a normal pregnancy [3], vaginal bleeding in the second half of pregnancy is linked to perinatal mortality, disorders of the amniotic fluid, premature rupture of membranes (PROM), preterm deliveries, low birth weight, and low neonatal Apgar scores [1].