Association between first-trimester vaginal bleeding and miscarriage.
Association between first-trimester vaginal bleeding and miscarriage.
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DOI：
10.1097/aog.0b013e3181b79796
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发表时间：
2009-10
影响因子：
7.2
通讯作者：
Hartmann KE
中科院分区：
文献类型：
--
作者：
Hasan R;Baird DD;Herring AH;Olshan AF;Jonsson Funk ML;Hartmann KE
估计妊娠早期出血与流产之间的关联强度，不考虑流产时的出血。在早孕前或早孕期间参加基于社区的妊娠队列研究的妇女。通过电话访谈收集详细的孕早期出血数据。排除了流产近端（4天内）的出血事件。我们使用离散时间风险模型来评估出血和流产之间的关联。模型根据母亲年龄、既往流产和吸烟情况进行调整。采用探索性回归树分析评价其他出血特征（持续时间、相关疼痛、颜色、时间）的相对重要性。在4510名参与者中，有1204名（27%）报告了妊娠早期阴道出血或点滴出血，观察到517例流产。8%的出血患者报告了严重出血事件。当我们评估任何出血时，包括仅点滴出血的发作，出血女性（n=1204）流产的未校正相对比值（OR）为1.1（95%置信区间[CI] 0.9-1.3）。然而，报告重度出血的女性（n=97）的流产风险几乎是妊娠早期未出血女性的3倍（OR 3.0，95% CI 1.9-4.6）。协变量调整对估计值影响不大。进一步的分析表明，伴有疼痛的大量出血的女性是大部分风险升高的人群。妊娠早期大量出血，特别是伴有疼痛时，与流产的风险较高有关。斑点和光事件不是，特别是如果只有持续1-2天。
To estimate the strength of association between first-trimester bleeding and miscarriage, setting aside the bleeding at time of loss. Women enrolled in a community-based pregnancy cohort study before or during early pregnancy. Detailed, first-trimester bleeding data were collected by telephone interview. Bleeding episodes proximal to miscarriage (within 4 days) were excluded. We used discrete-time hazard models to evaluate the association between bleeding and miscarriage. Models were adjusted for maternal age, prior miscarriage, and smoking. Exploratory regression tree analysis was used to evaluate the relative importance of other bleeding characteristics (duration, associated pain, color, timing). Of the 4510 participants, 1204 (27%) reported some first-trimester vaginal bleeding or spotting, and 517 miscarriages were observed. Eight percent of those with bleeding reported heavy bleeding episodes. When we evaluated any bleeding, including episodes of only spotting, the unadjusted relative odds (OR) of miscarriage for women with bleeding (n=1204) was 1.1 (95% confidence interval [CI] 0.9–1.3). However, women who reported heavy bleeding (n=97)had nearly three times the risk of miscarriage compared to women without bleeding during the first trimester (OR 3.0, 95% CI 1.9–4.6). Adjustment for covariates had little effect on estimates. Further analyses suggested that women with heavy bleeding accompanied by pain were the group accounting for most of the elevated risk. Heavy bleeding in the first trimester, particularly when accompanied by pain, is associated with higher risk of miscarriage. Spotting and light episodes are not, especially if only lasting 1–2 days..