Vaginal bleeding and nausea in early pregnancy as predictors of clinical pregnancy loss.
Vaginal bleeding and nausea in early pregnancy as predictors of clinical pregnancy loss.
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DOI：
10.1016/j.ajog.2020.04.002
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发表时间：
2020-10
影响因子：
9.8
通讯作者：
Schisterman EF
中科院分区：
文献类型：
--
作者：
DeVilbiss EA;Naimi AI;Mumford SL;Perkins NJ;Sjaarda LA;Zolton JR;Silver RM;Schisterman EF
虽然恶心和阴道出血通常发生在妊娠早期，但它们在预测临床妊娠损失方面的预后价值尚不清楚。这项研究的目的是了解出血和恶心症状的时间是否可以用来预测超声确认怀孕的妇女的妊娠丢失风险。一组701名有临床确诊妊娠和1至2次妊娠丢失的妇女参加了阿司匹林对妊娠和生殖的影响试验(2006-2012)。参与者完成怀孕2-8周的每日症状日记，并接受前瞻性监测，以检测是否有妊娠丢失。评估每一种观察到的出血和恶心模式的妊娠丢失风险，并计算每种模式的阳性预测值和阴性预测值。在701名女性中，211名(30.1%)报告有阴道出血，639名(91.2%)报告有恶心。女性经历的大多数出血都是点状的，并在一次发作中得到控制。妊娠2~4周、4~6周、6~8周内阴道出血发生率分别为5.9%(41例)、14.6%(102例)、20.8%(146例)，分别为活产5.7%，临床妊娠丢失7.1%，活产18.4%，临床妊娠丢失32.4%。在同一孕期内，恶心发生率为22.7%(159例)(活产23.2%，临床妊娠丢失20.4%)，65.9%(462例)(67.5%活产，58.4%临床妊娠丢失)，87.0%(610例)(90.6%活产，69.0%临床妊娠丢失)。妊娠6~8周无恶心出血者(3.6%)临床妊娠丢失风险最大(风险差=56.1%，95%可信区间37.6~74.7)，阳性预测值68.0%(49.7%，86.3%)，阴性预测值85.8%(83.2%，88.4%)，阳性似然比11.1(2.04，20.1)，阴性似然比0.86(0.79，0.93)。恶心和出血是预测临床妊娠损失的临床因素(曲线下面积，0.87；95%可信区间，0.81-0.88)，与在怀孕前测量的年龄、体重指数、血压和腰臀比(曲线下面积，0.81；95%可信区间，0.78-0.88)相似。在怀孕6至8周期间经历出血而没有恶心的妇女，临床妊娠丢失的风险增加。出血和恶心不是妊娠6周前临床妊娠丢失的预测危险因素。
Although nausea and vaginal bleeding are commonly experienced in early pregnancy, their prognostic value in predicting clinical pregnancy loss is not well understood. This study aimed to understand whether timing of bleeding and nausea symptoms can be used to predict risk of pregnancy loss among women with ultrasound-confirmed pregnancies. A cohort of 701 women with clinically confirmed pregnancies and 1 to 2 previous pregnancy losses were preconceptionally enrolled in the Effects of Aspirin in Gestation and Reproduction trial (2006–2012). Participants completed daily symptom diaries from 2 to 8 weeks’ gestation and were prospectively monitored for detection of pregnancy loss. The risk of pregnancy loss was estimated for each observed bleeding and nausea pattern, and positive and negative predictive values for each pattern were calculated. Among 701 women, 211 (30.1%) reported any vaginal bleeding, and 639 (91.2%) reported any nausea. Most bleeding experienced by women was spotting and contained within a single episode. Within 2 to <4, 4 to <6, and 6 to 8 weeks’ gestation, vaginal bleeding occurred in 5.9% (41) (5.7% live birth, 7.1% clinical pregnancy loss), 14.6% (102) (13.9% live birth, 18.6% clinical pregnancy loss), and 20.8% (146) (18.4% live birth, 32.4% clinical pregnancy loss) of women, respectively. Within the same gestational periods, nausea was reported in 22.7% (159) (23.2% live birth, 20.4% clinical pregnancy loss), 65.9% (462) (67.5% live birth, 58.4% clinical pregnancy loss), and 87.0% (610) (90.6% live birth, 69.0% clinical pregnancy loss) of women. Women who had bleeding without nausea between 6 and 8 weeks’ gestation (3.6% prevalance) had the greatest risk of clinical pregnancy loss (risk difference=56.1%; 95% confidence interval, 37.6–74.7), a positive predictive value of 68.0% (49.7%, 86.3%), negative predictive value of 85.8% (83.2%, 88.4%), positive likelihood ratio of 11.1 (2.04, 20.1), and negative likelihood ratio of 0.86 (0.79, 0.93). Nausea and bleeding are clinical factors that predicted clinical pregnancy loss (area under the curve, 0.87; 95% confidence interval, 0.81–0.88) similar to age, body mass index, blood pressure, and waist-to-hip ratio (area under the curve, 0.81; 95% confidence interval, 0.78–0.88) measured preconceptionally. Women experiencing bleeding without nausea between 6 and 8 weeks’ gestation had an increased risk of clinical pregnancy loss. Bleeding and nausea were not predictive risk factors of clinical pregnancy loss prior to 6 weeks’ gestation.
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DOI：
10.1016/s0002-9378(96)70339-3
发表时间：
1996-03-01
影响因子：
9.8
作者：
Ball, RH;Ade, CM;Crane, JP
通讯作者：
Crane, JP
DOI：
10.1080/01674820701687521
发表时间：
2008-01-01
影响因子：
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通讯作者：
Rauchfuss, Martina
DOI：
10.1016/0002-9378(86)90337-6
发表时间：
1986-11-01
影响因子：
9.8
作者：
TIERSON, FD;OLSEN, CL;HOOK, EB
通讯作者：
HOOK, EB
影响因子：
4.7
作者：
Brisch, KH;Munz, D;Kreienberg, R
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影响因子：
2.5
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Gaudet, Caroline