Vaginal Bleeding in Pregnancy

Basics

Description

  • Major cause of maternal/fetal morbidity and mortality
  • Early pregnancy hemorrhage (≤20 wk):
    • Occurs in 30% of all pregnancies
    • 50% lead to spontaneous abortion
  • Late pregnancy hemorrhage (>20 wk):
    • Occurs in 3–5% of all pregnancies
  • Risk factors:
    • Advanced maternal age
    • Substance abuse
    • Pelvic inflammatory disease (PID)
    • Previous cesarean section
    • Previous termination of pregnancy
    • Previous dilation and curettage (D&C)
    • Previous ectopic pregnancy
    • Increased parity
    • Multiple gestation
    • Preeclampsia
    • Hypertension
    • Trauma
    • Use of assisted reproductive technology
  • Genetics:
    • 50–60% of miscarriages due to chromosomal abnormalities

Etiology

  • Vaginal
  • Cervical
  • Uterine
  • Uterine–placental interface
  • Hematologic dysfunction

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