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First-Trimester Vaginal Bleeding and Complications Later in Pregnancy

Lykke, Jacob Alexander MD; Dideriksen, Katrine Lehrmann MD; Lidegaard, Øjvind MD, DMSc; Langhoff-Roos, Jens MD, DMSc

doi: 10.1097/AOG.0b013e3181da8d38
Original Research

OBJECTIVE: To evaluate the association of first-trimester bleeding without miscarriage and complications later in the first pregnancy as well as in the next pregnancy.

METHODS: In a retrospective, registry-based cohort study, we identified women delivering in Denmark from 1978 to 2007 with a first singleton pregnancy (n=782,287) and first and second singleton pregnancies (n=536,419). First-trimester bleeding is defined as vaginal bleeding before 12 full weeks of gestation. We employed multivariate logistic regression with adjustment for maternal age and calendar year.

RESULTS: First-trimester bleeding increased the risk of delivery in weeks 32–36 from 3.6% to 6.1% (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.57–1.77) and in weeks 28–31 from 0.3% to 0.9% (OR 2.98; 95% CI 2.50–3.54) and increased the risk of placental abruption from 1.0% to 1.4% (OR 1.48; 95% CI 1.30–1.68).

First-trimester bleeding in the first pregnancy increased the risk of recurrence in the second pregnancy from 2.2% to 8.2% (OR 4.05; 95% CI 3.78–4.34), preterm delivery from 2.7% to 4.8% (OR 1.83; 95% CI 1.67–2.00), and placental abruption from 0.9% to 1.0% (OR 1.29; 95% CI 1.07–1.56) in the second pregnancy.

CONCLUSION: Women with first-trimester bleeding in the first pregnancy have an increased risk of complications later in the first pregnancy and of recurrence of first-trimester bleeding and other complications in the second pregnancy.


First-trimester vaginal bleeding is associated with complications later in the first pregnancy and carries a risk over into the second pregnancy as well. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

From the Department of Obstetrics and Gynecology, Roskilde Hospital, Roskilde; and the Department of Obstetrics and Gynecology, Rigshospitalet, Copenhagen, Denmark.

A list of diagnoses and International Classification of Diseases (ICD)-8 and ICD-10 codes pertaining to this article is available in the Appendix online at

Corresponding author: Jacob Alexander Lykke, MD, Department of Obstetrics and Gynecology, Roskilde Hospital, Kogevej 7, 4000 Roskilde, Denmark; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.