Early vaginal bleeding, late prenatal care, and misdating in adolescent pregnancies

Vaginal bleeding early in pregnancy may be mistaken for menstrual bleeding and delay entry into prenatal care by delaying the diagnosis of pregnancy. This study tests the hypotheses that (1) more adolescents report early first-trimester vaginal bleeding than do adults and (2) a history of vaginal bleeding is associated with later entry into prenatal care, particularly among adolescents. Reports of early vaginal bleeding were prospectively obtained from black, predominantly primiparous, unmarried poor women (136 adolescents and 53 adults). As hypothesized, more adolescents reported early first-trimester vaginal bleeding than did adults (16.9% vs 5.7%; P less than .01). Adolescents who reported early vaginal bleeding also entered prenatal care later (16.2 weeks) than did adolescents who reported no bleeding (12.7 weeks) (P less than .03); this was not true for adults. If dating of the gestation is based solely on last menstrual period history, inflation of the incidence of preterm births to adolescents and the mean birth weights of those preterm neonates may occur. The findings suggest that new strategies focusing on the recognition of menstrual irregularities as a symptom of pregnancy may be needed to promote early prenatal care among adolescents. Additionally, adolescent pregnancies should be dated by both ultrasound and Dubowitz examinations.