Advertisement
JOGC
Advanced searchSave search
OBSTETRICS| Volume 34, ISSUE 11, P1043-1052, November 2012

Download started.

Ok

Indications for, Timing of, and Modes of Delivery in a National Cohort of Women Admitted With Antepartum Hemorrhage at 22+0 to 28+6 Weeks’ Gestation

DOI:https://doi.org/10.1016/S1701-2163(16)35434-2
Indications for, Timing of, and Modes of Delivery in a National Cohort of Women Admitted With Antepartum Hemorrhage at 22+0 to 28+6 Weeks’ Gestation
Previous ArticleAre Pregnant and Postpartum Women Moodier? Understanding Perinatal Mood Instability
Next ArticleSentinel Lymph Node Biopsy in Vulvar Cancer: A Health Technology Assessment for the Canadian Health Care Context
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Objective

      Antepartum hemorrhage is associated with preterm birthand operative delivery. Since the Canadian Perinatal Networkrecords obstetric interventions for women admitted to tertiarycare hospitals with antepartum hemorrhage, our objective was todescribe the delivery characteristics of this cohort.

      Methods

      Trained abstractors collected data by chart review fromwomen admitted with antepartum hemorrhage between 22+0 and28+6 weeks’ gestation. We included all women with completefollow-up postpartum and used descriptive statistics to report theindications for, timing of, and modes of delivery.

      Results

      The study cohort included 806 women from 13 tertiaryperinatal centres in six provinces. The most common causes ofbleeding were placental abruption (n = 256) and placenta previa(n = 171). The median gestational age at delivery was 30 weeks,and 497 (61.7%) births occurred at less than 34 weeks. Over onehalf of the women began labour spontaneously, and 238 (29.5%)were delivered prior to the onset of labour. Overall, 370 (45.9%)women delivered vaginally, including 98 who had induction oflabour. Of the 436 Caesarean sections (54.1%), 345 (79.1%)were emergencies. The most common indications for Caesareansection were placenta previa, abnormal fetal presentation, andplacental abruption or vaginal bleeding.

      Conclusion

      This inpatient cohort of women with antepartumhemorrhage had high rates of spontaneous labour, preterm birth,and emergency Caesarean section. These results can be used ascurrent Canadian benchmark rates of preterm delivery, inductionof labour, and Caesarean section in women admitted to tertiarycare centres with antepartum hemorrhage between 22+0 and 28+6weeks’ gestation, and can aid in the counselling of similar women.

      Résumé

      Objectif

      L’hémorragie antepartum est associée à l’accouchementpréterme et opératoire. Puisque le Réseau périnatal canadienconsigne les interventions obstétricales menées chez lesfemmes admises dans les hôpitaux de soins tertiaires en raisond’une hémorragie antepartum, notre objectif était de décrire lescaractéristiques de l’accouchement au sein de cette cohorte.

      Méthodes

      Des résumeurs formés ont recueilli des données aumoyen de l’analyse des dossiers des femmes hospitalisées enraison d’une hémorragie antepartum entre 22+0 et 28+6 semainesde gestation. Nous avons inclus toutes les femmes comptant unsuivi postpartum exhaustif et nous avons fait appel à la statistiquedescriptive pour signaler les paramètres suivants en ce qui a traità l’accouchement : indications, chronologie et modes utilisés.

      Résultats

      La cohorte d’étude comptait 806 femmes en provenancede 13 centres périnataux tertiaires dans six provinces. Lescauses les plus courantes de l’hémorragie étaient le décollementplacentaire (n = 256) et le placenta prævia (n = 171). L’âgegestationnel médian au moment de l’accouchement était de30 semaines et 497 accouchements (61,7 %) ont eu lieu à moinsde 34 semaines. Plus de la moitié des femmes ont connu untravail spontané et 238 femmes (29,5 %) ont accouché avantle début du travail. En tout, 370 femmes (45,9 %) ont connu unaccouchement vaginal, dont 98 qui ont subi un déclenchementdu travail. Parmi les 436 césariennes menées (54,1 %), 345 (79,1 %) étaient des urgences. Les indications les plus courantesde césarienne étaient le placenta prævia, la présentation foetaleanormale et le décollement placentaire ou le saignement vaginal.

      Conclusions

      Cette cohorte de femmes hospitalisées en raisond’une hémorragie antepartum présentait des taux élevés detravail spontané, d’accouchement préterme et de césarienned’urgence. Ces résultats peuvent être utilisés à titre de taux deréférence canadiens actuels en ce qui a trait à l’accouchementpréterme, au déclenchement du travail et à la césarienne chezles femmes admises en centre de soins tertiaires, entre 22+0et 28+6 semaines de gestation, en raison d’une hémorragieantepartum, ainsi que contribuer au counseling des femmes setrouvant dans des situations semblables.

      Key Words

      REFERENCES

        • Axelsen S.M.
        • Henriksen T.B.
        • Hedegaard M.
        • Secher N.J.
        Characteristics of vaginal bleeding during pregnancy.
        Eur J Obstet Gynecol Reprod Biol. 1995; 63: 131-134
        • Hossain R.
        • Harris T.
        • Lohsoonthorn V.
        • Williams M.A.
        Risk of preterm delivery in relation to vaginal bleeding in early pregnancy.
        Eur J Obstet Gynecol Reprod Biol. 2007; 135: 158-163
        • Strobino B.
        • Pantel-Silverman J.
        Gestational vaginal bleeding and pregnancy outcome.
        Am J Epidemiol. 1989; 129: 806-815
        • South J.
        • Naldrett J.
        The effect of vaginal bleeding in early pregnancy on the infant born after the 28th week of pregnancy.
        J Obstet Gynaecol Br Commonw. 1973; 80: 236-241
        • Sipila P.
        • Hartikainen-Sorri A.L.
        • Oja H.
        • Von Wendt L.
        Perinatal outcome of pregnancies complicated by vaginal bleeding.
        Br J Obstet Gynaecol. 1992; 99: 959-963
        • Yang J.
        • Savitz D.A.
        • Dole N.
        • Hartmann K.E.
        • Herring A.H.
        • Olshan A.F.
        • et al.
        Predictors of vaginal bleeding during the first two trimesters of pregnancy.
        Paediatr Perinat Epidemiol. 2005; 19: 276-283
        • Towers C.V.
        • Burkhart A.E.
        Pregnancy outcome after a primary antenatal hemorrhage between 16 and 24 weeks’ gestation.
        Am J Obstet Gynecol. 2008; 198: 1-5
        • Norwitz E.R.
        • Park J.S.
        Overview of the etiology and evaluation of vaginal bleeding in pregnant women. UpToDate 2011.
        (Available at:)
        www.uptodate.com/contents/overview-of-the-etiologyand-evaluation-of-vaginal-bleeding-in-pregnant-women
        (Accessed August 25, 2012)
        • Ananth C.V.
        • Savitz D.A.
        Vaginal bleeding and adverse reproductive outcomes: a meta-analysis.
        Paediatr Perinat Epidemiol. 1994; 8: 62-78
        • Harlev A.
        • Levy A.
        • Zaulan Y.
        • Koifman A.
        • Mazor M.
        • Wiznitzer A.
        • et al.
        Idiopathic bleeding during the second half of pregnancy as a risk factor for adverse perinatal outcome.
        J Matern Fetal Neonatal Med. 2008; 21: 331-335
        • Signore C.C.
        • Sood A.K.
        • Richards D.S.
        Second-trimester vaginal bleeding: correlation of ultrasonographic findings with perinatal outcome.
        Am J Obstet Gynecol. 1998; 178: 336-340
        • Koifman A.
        • Levy A.
        • Zaulan Y.
        • Harlev A.
        • Mazor M.
        • Wiznitzer A.
        • et al.
        The clinical significance of bleeding during the second trimester of pregnancy.
        Arch Gynecol Obstet. 2008; 278: 47-51
        • Yang J.
        • Hartmann K.E.
        • Savitz D.A.
        • Herring A.H.
        • Dole N.
        • Olshan A.F.
        • et al.
        Vaginal bleeding during pregnancy and preterm birth.
        Am J Epidemiol. 2004; 160: 118-125
        • Yang J.
        • Savitz D.A.
        The effect of vaginal bleeding during pregnancy on preterm and small-for-gestational-age births: US national maternal and infant health survey, 1988.
        Obstet Gynecol Surv. 2001; 56: 449-450
        • Lipitz S.
        • Admon D.
        • Menczer J.
        • Ben-Baruch G.
        • Oelsner G.
        Midtrimester bleeding—variables which affect the outcome of pregnancy.
        Gynecol Obstet Invest. 1991; 32: 24-27
        • Nielson E.C.
        • Varner M.W.
        • Scott J.R.
        The outcome of pregnancies complicated by bleeding during the second trimester.
        Surg Gynecol Obstet. 1991; 173: 371-374
      17. Canadian Perinatal Network.2010 [updated December 12, 2010].
        (Available at:)
        www.cpn-rpc.org
        (Accessed October 15, 2011)
        • Ezzat H.
        • Ross S.
        • von Dadelszen P.
        • Morris T.
        • Liston R.
        • Magee L.A.
        • et al.
        Ethics review as a component of institutional approval for a multicentre continuous quality improvement project: the investigator’s perspective.
        BMC Health Serv Res. 2010; 10: 223
        • Magee L.A.
        • von Dadelszen P.
        • Allen V.M.
        • Ansermino J.M.
        • Audibert F.
        • Barrett J.
        • et al.
        The Canadian Perinatal Network: a national network focused on threatened preterm birth at 22 to 28 weeks’ gestation.
        J Obstet Gynaecol Can. 2011; 33: 111-120
        • Robinson J.
        • Norwitz E.
        Risk factors for preterm labor and delivery. UptoDate 2012.
        (Available at:)
        www.uptodate.com/contents/risk-factors-for-preterm-labor-and-delivery
        (Accessed August 25, 2012)
        • Clark E.A.
        • Silver R.M.
        Long-term maternal morbidity associated with repeat cesarean delivery.
        Am J Obstet Gynecol. 2011; 205 (suppl): 2-10
        • Lykke J.A.
        • Paidas M.J.
        • Langhoff-Roos J.
        Recurring complications in second pregnancy.
        Obstet Gynecol. 2009; 113: 1217-1224
        • Barrett J.
        • Bocking A.
        Management of twin pregnancies (Part 1). The SOGC consensus statement. SOGC Clinical Practice Guideline, No. 91, July 2000.
        J Soc Obstet Gynaecol Can. 2000; 22: 519-531
      24. Sheiner E. Bleeding during pregnancy: a comprehensive guide. Springer Science+Business Media, New York2011
        • Dani C.
        • Poggi C.
        • Bertini G.
        • Pratesi S.
        • Di Tommaso M.
        • Scarselli G.
        • et al.
        Method of delivery and intraventricular haemorrhage in extremely preterm infants.
        J Matern Fetal Neonatal Med. 2010; 23: 1419-1423
        • Ment L.R.
        • Oh W.
        • Ehrenkranz R.A.
        • Philip A.G.
        • Duncan C.C.
        • Makuch R.W.
        Antenatal steroids, delivery mode, and intraventricular hemorrhage in preterm infants.
        Am J Obstet Gynecol. 1995; 172: 795-800
        • Hogberg U.
        • Holmgren P.A.
        Infant mortality of very preterm infants by mode of delivery, institutional policies and maternal diagnosis.
        Acta Obstet Gynecol Scand. 2007; 86: 693-700
        • Magann E.F.
        • Cummings J.E.
        • Niederhauser A.
        • Rodriguez-Thompson D.
        • McCormack R.
        • Chauhan S.P.
        Antepartum bleeding of unknown origin in the second half of pregnancy: a review.
        Obstet Gynecol Surv. 2005; 23: 741-745
      29. Statistics Canada. Births (2008) catalogue no. 84F0210XWE.
        Statistics Canada, Ottawa2011 (Available at:)
        www.statcan.gc.ca
        (Accessed November 30, 2011)
        • Massey K.A.
        • Magee L.A.
        • Dale S.
        • Claydon J.
        • Morris T.J.
        • von Dadelszen P.
        • et al.
        A current landscape of provincial perinatal data collection in Canada.
        J Obstet Gynaecol Can. 2009; 31: 236-246
        • Spong C.Y.
        • Mercer B.M.
        • D’alton M.
        • Kilpatrick S.
        • Blackwell S.
        • Saade G.
        Timing of indicated late-preterm and early-term birth.
        Obstet Gynecol. 2011; 118 (2 Pt 1): 323-333
        • Liu S.
        • Liston R.M.
        • Joseph K.S.
        • Heaman M.
        • Sauve R.
        • Kramer M.S.
        • et al.
        Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.
        CMAJ. 2007; 176: 455-460

      Article info

      Publication history

      Accepted: June 21, 2012
      Received: February 16, 2012

      Footnotes

      This paper was presented at the ACOG Districts VIII & IX 2011 Annual District Meeting in Los Cabos, Baja California Sur, Mexico, October 30th, 2011.

      Competing Interests: None declared.

      Identification

      DOI: https://doi.org/10.1016/S1701-2163(16)35434-2

      Copyright

      © 2012 Society of Obstetricians and Gynaecologists of Canada. Published by Elsevier Inc. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX