Department of Epidemiology, Caphri School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
Acta Obstet Gynecol Scand. 2012 Nov;91(11):1331-8. doi: 10.1111/j.1600-0412.2012.01496.x. Epub 2012 Aug 22.
To describe patterns of vaginal bleeding in the first 20 weeks of pregnancy and evaluate the association between patterns of bleeding and risk of subsequent pre-eclampsia in nulliparous women.
Cohort study.
Participating centres of the Screening for Pregnancy Endpoints (SCOPE) study in Auckland (New Zealand), Adelaide (Australia), Manchester and London (UK) and Cork (Ireland).
Healthy nulliparous women (n= 3431).
Logistic regression was used to assess the association between bleeding characteristics and pre-eclampsia while controlling for known determinants of pre-eclampsia.
Preeclampsia, defined as gestational hypertension with proteinuria or any multi-system complication of preeclampsia. Four bleeding variables were evaluated: any bleeding during the first 20 weeks; maximal bleeding intensity; duration of bleeding; and number of bleeding episodes.
Of the 3431 women enrolled, 780 (23%) experienced vaginal bleeding during the first 20 weeks of pregnancy. Risk of pre-eclampsia was not associated with the presence or absence of bleeding (adjusted odds ratio (ORa) 0.96, 95% confidence interval (95% CI) 0.67-1.38). Analyses confined to women with vaginal bleeding showed that any bleeding episode of five or more consecutive days, compared with shorter episodes, increased risk of pre-eclampsia approximately twofold (ORa 2.15, 95% CI 1.01-4.57), as did multiple compared with single episodes of bleeding (ORa 2.33, 95% CI 1.16-4.67).
Bleeding is a common complication during the first 20 weeks of nulliparous pregnancy, and the presence or absence of vaginal bleeding is not a determinant of subsequent pre-eclampsia. Among women with vaginal bleeding, consideration of the bleeding pattern, in terms of intensity, duration and frequency, appears to be informative with respect to pre-eclampsia risk.
描述初产妇妊娠 20 周内阴道出血模式，并评估其与随后发生子痫前期的风险之间的关联。
队列研究。
奥克兰（新西兰）、阿德莱德（澳大利亚）、曼彻斯特和伦敦（英国）和科克（爱尔兰）的妊娠终点筛查（SCOPE）研究参与中心。
健康初产妇（n=3431）。
使用逻辑回归来评估出血特征与子痫前期之间的关联，同时控制子痫前期的已知决定因素。
子痫前期，定义为妊娠高血压伴蛋白尿或任何多系统子痫前期并发症。评估了四个出血变量：妊娠 20 周内任何出血；最大出血强度；出血持续时间；和出血发作次数。
在 3431 名入组的妇女中，780 名（23%）在妊娠的前 20 周内出现阴道出血。子痫前期的风险与出血的有无无关（调整后的优势比（ORa）0.96，95%置信区间（95%CI）0.67-1.38）。对有阴道出血的妇女进行的分析表明，与较短的出血发作相比，连续五天或以上的任何出血发作都会使子痫前期的风险增加约两倍（ORa 2.15，95%CI 1.01-4.57），而与单一出血发作相比，多次出血发作的风险增加（ORa 2.33，95%CI 1.16-4.67）。
出血是初产妇妊娠前 20 周常见的并发症，阴道出血的有无不是随后发生子痫前期的决定因素。在有阴道出血的妇女中，考虑出血模式（包括强度、持续时间和频率）似乎与子痫前期的风险有关。
