News from ACOG 2018: First trimester bleeding linked to increased risk of retained placenta

Women who have a history of first-trimester hemorrhage face 8 times the increased risk of undergoing D&C for removal of the retained placenta as compared to women with a history of bleeding reports the result of a study presented at American College of Obstetricians and Gynecologists (ACOG) 2018 annual meeting at Austin, Texas.

This abstract also won the first prize among the oral award winners at the conference.

These women also have a higher incidence of postpartum hemorrhage and require blood transfusions more frequently says Marissa Le Gallee, of Jewish General Hospital in Montreal, and colleagues who conducted the research.

This case-control study was conducted over a period of four years (2012-2016) at a tertiary care center in Montréal, Canada. Subchorionic hemorrhage was identified by the patient's obstetric history on as an anechoic structure visualized on ultrasound.

The authors recruited 68 cases who had post vaginal delivery D&C for retained placenta and matched them to 330 controls who delivered on the same day but did not have D&C after going through the medical records.

The demographics of cases and controls were similar, except women requiring a D&C for placental removal were slightly older than controls. The incidence of retained placenta requiring D&C was 3/1000 deliveries.

There were 11 women with a history of the first trimester bleeding who underwent post-partum D&C as compared with only two controls without a D&C (adjusted OR 35.00, 95% CI 6.96-175.69, P=0.0002).

This association strongly existed even after adjusting for confounders (OR 7.70, CI 1.-37.5).

A significant number of women who had undergone D&C lost blood greater than 500ml and needed manual removal as well as blood transfusions compared with patients with no D&C.

Dr. Le Gallee hypothesized that Subchorionic bleed leads to adhesion of portions of the placenta that necessitates D&C at birth. It is also associated with placental abruptions and preterm births.

The authors concluded that women with a history of the first-trimester bleed should be watched carefully watched for other potential pregnancy and peripartum complications.

Abstract

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