[Metrorrhagia during the second trimester of pregnancy: obstetrical and perinatal outcome. A retrospective study including 85 cases].

Objective Of The Study: To examine pregnancy outcome in patients with second-trimester vaginal bleeding and to determine a relationship between presumed etiology and perinatal outcome.

Material: and methods: A retrospective study performed in Toulouse La Grave CHU between January 1993 and December 1997 including 85 cases of vaginal bleeding from 15 to 27 week's amenorrhea (90 fetuses). Results are compared to overall deliveries during the same period (14941 deliveries).

Results: Mean age at diagnosis is 29.8 years (SD: 5.3 years). Vaginal bleeding in the midtrimester concern 0.57% of deliveries. Abnormal ultrasonographic findings are observed in 73% of patients (placenta previa, subchorionic hematoma, placental abruption) and 81% were hospitalized (mean hospital duration: 18 days). Perinatal mortality was 17.04% and preterm delivery rate 30.6% (vs 11% in the overall patients). Perinatal complications are significatively increased compared with the overall population especially if ultrasonographic examination was abnormal. Second-trimester placental abruption had the worse prognosis. On the other hand, perinatal outcome was comparable when the origin of bleeding was unknown and ultrasonographic examination normal. 41% patients underwent cesarean section.

Conclusion: Preterm delivery, perinatal mortality and morbidity are increased in patients with second-trimester vaginal bleeding. The risk is higher when abnormalities are detected at ultrasonography making ultrasonography a useful tool for predicting perinatal outcome.