2ND-TRIMESTER VAGINAL BLEEDING - CORRELATION OF ULTRASONOGRAPHIC FINDINGS WITH PERINATAL OUTCOME

OBJECTIVE: Our purpose was to determine the relationship between ultra sonographic findings and perinatal outcome in patients with second-tri mester vaginal bleeding. STUDY DES[GN: A retrospective case-control st udy was performed. One hundred sixty-seven patients with ultrasonograp hic examinations performed for bleeding between 13 and 26 weeks' gesta tion were identified through a comprehensive ultrasonography database. The main ultrasonographic findings of interest were the presence of a n intrauterine clot, membrane separation, and placenta previa. A contr ol group of 167 patients was obtained by selecting the next consecutiv e patient from the comprehensive perinatal database. Perinatal outcome measures for both groups were recorded. RESULTS: Multiparity was more common in patients with bleeding than in controls (69% vs 58%, p = 0. 036), as was history of two or more previous preterm deliveries (6% vs none: p = 0.005). Second-trimester vaginal bleeding was associated wi th increased risk of preterm delivery (relative risk 1.9, 95% confiden ce interval 1.4 to 2.8), fetal death (relative risk 6.3, 95% confidenc e interval 1.9 to 2.1), and perinatal death (relative risk 5.4, 95% co nfidence interval 2.1 to 13.7). The perinatal mortality rate was 162:1 000 in these patients versus 30:1000 in controls. To assess the impact of ultrasonographic abnormalities, the study group was divided into t wo groups, Among the patients with second-trimester vaginal bleeding t hose with abnormal ultrasonographic findings had an increased risk of preterm delivery (relative risk 2.0, 95% confidence interval 1.4 to 2. 8), fetal death (relative risk 2.6, 95% confidence interval 1.1 to 6.3 ), perinatal death (relative risk 2.6, 95% confidence interval 1.3 to 5.3), and neonatal intensive care unit admissions (relative risk 3.2, 95% confidence interval 1.6 to 6.1). The perinatal mortality rate was 258:1000 for patients with abnormal ultrasonographic examinations. CON CLUSION: Second-trimester vaginal bleeding is more common in multiparo us women and in women with a history of a previous preterm delivery. P erinatal morbidity and mortality is increased in patients with bleedin g during the second trimester. The risk is compounded when abnormaliti es are detected by ultrasonography.