AUSTIN, Texas -- Women with bleeding during pregnancy had a greater risk of post-partum dilation and curettage (D&C) for retained placenta, researchers said here.
Subchorionic bleeding in the first trimester was linked with an increased risk of experiencing a post-partum D&C, reported Marissa Le Gallee, of Jewish General Hospital in Montreal, and colleagues.
occurs in an estimated 1% of pregnancies, Le Gallee said in a presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
She added that this may lead to the adhesion of the placenta to the uterine wall, so that portions of the placenta are not voided at birth, "which would necessitate the use of a D&C."
Courtney Olsen-Chen, MD, of the University of Rochester Medical Center in New York, said she found these results surprising.
"It seems to me that development of a subchorionic hemorrhage would actually form a barrier between the placenta and the uterine wall leading to less abnormal invasive placentation," she told 51˶.
Le Gallee's group performed a case-control study in a tertiary care teaching hospital in Montreal. Participants were live, singleton vaginal births from 2012 to 2016. Cases had a D&C, while controls did not, the authors noted. Subchorionic hemorrhage was defined as an anechoic structure visualized on ultrasound, or as mentioned in the patient's obstetrical history.
Overall, 68 cases were matched to 330 controls, matched to the same day of delivery within 1-2 days. There were 11 women with a post-partum D&C who experienced any subchorionic bleeding compared with only two controls without a D&C (adjusted OR 35.00, 95% CI 6.96-175.69, P=0.0002).
Eight women with a first trimester bleed had a post-partum D&C versus two who did not have a D&C (adjusted OR 22.53, 95% CI 4.73-135.41, P<0.0001). Le Gallee noted the extremely wide confidence intervals during the presentation, and said it was due the small cohort and the fact that subchorionic hemorrhage is a rare occurrence.
"We hypothesized that subchorionic hemorrhages are underreported by physicians and are not routinely confirmed as a cause of early pregnancy bleeding, given that only two controls and eight cases were diagnosed with a first trimester bleed," she said.
The authors also found that significantly greater portions of patients requiring a D&C had blood loss of >0.5 L and the need for both manual revisions and blood transfusions compared with patients with no D&C.
Olsen-Chen, who was not involved in the study, added that vaginal bleeding in the first trimester is known to be associated with adverse outcomes, including chronic placental abruption and preterm birth.
"I think this study reminds us that women with bleeding in the first trimester are at an increased risk of a multitude of potential pregnancy complications. In general, routine prenatal and peripartum care will be adequate for monitoring for the development of complications like retained placenta," she said.
Le Gallee said her group is conducting a prospective study in which they evaluate emergency department (ED) ultrasound scans, and determine whether or not there was a subchorionic hemorrhage. They will then investigate whether it was referred by the ED physician when the patient presented with first trimester bleeding, as well as following up with the patient for potential complications.
"So far, 39 [ED] ultrasound scans have been reviewed where 60% of subchorionic hemorrhages are underreported," she said.
Disclosures
Le Gallee and co-authors disclosed no relevant relationships with industry.
Primary Source
American College of Obstetricians and Gynecologists
Le Gallee M, et al "Effect of first trimester bleeding on retained placenta requiring dilatation and curettage" ACOG 2018; Abstract 20OP.