Weiss Joshua L, Malone Fergal D, Vidaver John, Ball Robert H, Nyberg David A, Comstock Christine H, Hankins Gary D, Berkowitz Richard L, Gross Susan J, Dugoff Lorraine, Timor-Tritsch Ilan E, D'Alton Mary E
Columbia Presbyterian Medical Center, New York, NY, USA.
Am J Obstet Gynecol. 2004 Mar;190(3):745-50. doi: 10.1016/j.ajog.2003.09.023.
The purpose of this study was to determine whether patients with first-trimester threatened abortion are at increased risk for poor pregnancy outcome.
A large prospective multicenter database was studied. Subjects were divided into three groups: (1) no bleeding, (2) light bleeding, and (3) heavy bleeding. Univariate and multivariable logistic regression analyses were used.
The study comprised 16,506 patients: 14,160 patients without bleeding, 2094 patients with light bleeding, and 252 patients with heavy bleeding. Patients with vaginal bleeding, light or heavy, were more likely to experience a spontaneous loss before 24 weeks of gestation (odds ratio, 2.5 and 4.2, respectively) and cesarean delivery (odds ratio, 1.1 and 1.4, respectively). Light bleeding subjects were more likely to have preeclampsia (odds ratio, 1.5), preterm delivery (odds ratio, 1.3), and placental abruption (odds ratio, 1.6). Heavy vaginal bleeding subjects were more likely to have intrauterine growth restriction (odds ratio, 2.6), preterm delivery (odds ratio, 3.0), preterm premature rupture of membranes (odds ratio, 3.2), and placental abruption (odds ratio, 3.6).
First-trimester vaginal bleeding is an independent risk factor for adverse obstetric outcome that is directly proportional to the amount of bleeding.
本研究旨在确定孕早期先兆流产患者出现不良妊娠结局的风险是否增加。
对一个大型前瞻性多中心数据库进行了研究。受试者分为三组：（1）无出血，（2）少量出血，（3）大量出血。采用单因素和多因素逻辑回归分析。
该研究纳入了16506例患者：14160例无出血患者，2094例少量出血患者，252例大量出血患者。有阴道出血（无论少量还是大量）的患者在妊娠24周前发生自然流产的可能性更大（比值比分别为2.5和4.2），剖宫产的可能性也更大（比值比分别为1.1和1.4）。少量出血的患者发生子痫前期（比值比为1.5）、早产（比值比为1.3）和胎盘早剥（比值比为1.6）的可能性更大。大量阴道出血的患者发生胎儿生长受限（比值比为2.6）、早产（比值比为3.0）、胎膜早破（比值比为3.2）和胎盘早剥（比值比为3.6）的可能性更大。
孕早期阴道出血是不良产科结局的独立危险因素，且与出血量成正比。
